Provider Demographics
NPI:1023163730
Name:MORENO, ISABELLA C (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:C
Last Name:MORENO
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:ISABELLA
Other - Middle Name:C
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDS, NCSP
Mailing Address - Street 1:913 E HEARNE WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5941
Mailing Address - Country:US
Mailing Address - Phone:480-634-5917
Mailing Address - Fax:
Practice Address - Street 1:913 E HEARNE WAY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5941
Practice Address - Country:US
Practice Address - Phone:480-892-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20562101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional