Provider Demographics
NPI:1770295230
Name:MORENO, SARA MICHELE (BHS, QMHP, QIDP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MICHELE
Last Name:MORENO
Suffix:
Gender:F
Credentials:BHS, QMHP, QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 W CARLETON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9458
Mailing Address - Country:US
Mailing Address - Phone:517-437-0117
Mailing Address - Fax:
Practice Address - Street 1:3200 W CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-9458
Practice Address - Country:US
Practice Address - Phone:517-437-0117
Practice Address - Fax:517-437-0033
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator