Provider Demographics
NPI:1134949928
Name:MORENO, ANGELA A (ASW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:A
Last Name:MORENO
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10417 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAMONT
Mailing Address - State:CA
Mailing Address - Zip Code:93241-1726
Mailing Address - Country:US
Mailing Address - Phone:661-845-5100
Mailing Address - Fax:661-845-5106
Practice Address - Street 1:10417 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMONT
Practice Address - State:CA
Practice Address - Zip Code:93241-1726
Practice Address - Country:US
Practice Address - Phone:661-845-5100
Practice Address - Fax:661-845-5106
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2025-09-24
Deactivation Date:2024-10-28
Deactivation Code:
Reactivation Date:2025-09-24
Provider Licenses
StateLicense IDTaxonomies
CAASW1320141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical