Provider Demographics
NPI:1528491834
Name:MORENO, MARCOS (LMSW)
Entity type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:
Last Name:MORENO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5154 N BUCKBOARD PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1871
Mailing Address - Country:US
Mailing Address - Phone:208-995-3664
Mailing Address - Fax:
Practice Address - Street 1:4120 N LINDER RD STE 109
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5416
Practice Address - Country:US
Practice Address - Phone:208-391-4841
Practice Address - Fax:208-391-4966
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-10
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-33200104100000X
IDLCSW-356721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker