Provider Demographics
NPI:1053614727
Name:MORENO, ROXANNE HORTA (LCSW)
Entity type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:HORTA
Last Name:MORENO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 ARTESIA BLVD STE 300E
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3269
Mailing Address - Country:US
Mailing Address - Phone:323-240-4450
Mailing Address - Fax:
Practice Address - Street 1:2512 ARTESIA BLVD STE 300E
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3269
Practice Address - Country:US
Practice Address - Phone:323-240-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW692591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical