Jeff Ryan Moreno, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-31828 Issued in ID

Practice address

923 16TH Ave S
Nampa, ID 83651-4731

Phone

(208) 639-1514

Fax

(208) 639-2301

NPI assigned

Dec 29, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stellar Mental Health & Mediation, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Nampa, ID
  • NPI 1902225436
  Medicare reassignment NPD
• Blue Sky Behavioral Health

  • Clinical Social Worker
  • Nampa, ID
  • NPI 1053199778
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689811200000",
    "number": "1083983514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "923 16TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836514731",
            "telephone_number": "208-639-1514",
            "fax_number": "208-639-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "923 16TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836514731",
            "telephone_number": "208-639-1514",
            "fax_number": "208-639-2301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5700 E Franklin Rd Ste 250",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836877902",
            "country_code": "US",
            "telephone_number": "208-570-8894",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORENO",
        "first_name": "JEFF",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-29",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-31828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kylee Okerlund Morales
• Alexandra Moraleta, RN IBCLC
• McKenzie Mary Morcom, CNP, PMHNP-BC
• Caitlin Alysse Moreland, DPT
• Darci D Moreno, LPC
• Ann Morgan, RRT
• Melissa Morgan
• Kirsten J Morigeau, MD
• Joseph Paul Morisette, LCPC
• Morris Physical Therapy, Inc.

• Clinical Social Worker in Nampa, ID
• Providers in Nampa, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.