Provider Demographics
NPI:1669006987
Name:MORENO, CASSIDY EMI ADAMS (MA, BCBA)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:EMI ADAMS
Last Name:MORENO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SANTA BARBARA AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4471
Mailing Address - Country:US
Mailing Address - Phone:626-233-9514
Mailing Address - Fax:
Practice Address - Street 1:277 SOUTH ST STE V
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5039
Practice Address - Country:US
Practice Address - Phone:805-242-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst