Provider Demographics
NPI:1265737928
Name:MORENO-RODRIGUEZ, GLORIA IVONNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:IVONNE
Last Name:MORENO-RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:IVONNE
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:514 49TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2010
Mailing Address - Country:US
Mailing Address - Phone:718-431-2600
Mailing Address - Fax:
Practice Address - Street 1:514 49TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2010
Practice Address - Country:US
Practice Address - Phone:718-431-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084904-011041C0700X
NY081124104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical