MEDICARE: PATRICIA PARRA MORENO LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	LG50082919	DC
2	1041C0700X	Clinical Social Worker	LC50082547	DC

General Provider Information

NPI Number	:	1740825736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA PARRA MORENO LICSW

Provider Business Mailing Address
First Line	:	1155 RIPLEY ST APT 1203
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-7462
Country	:	US
Telephone Number	:	760-616-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 RIPLEY ST APT 1203
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-7462
Country	:	US
Telephone Number	:	760-616-0793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2019
Last Update Date	:	12/28/2020

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