Provider Demographics
NPI:1023501822
Name:MORENO, DAVID (BACHELORS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:MORENO
Suffix:
Gender:M
Credentials:BACHELORS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7480
Mailing Address - Country:US
Mailing Address - Phone:347-713-2653
Mailing Address - Fax:
Practice Address - Street 1:1918 AVENUE H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7480
Practice Address - Country:US
Practice Address - Phone:347-713-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician