Active NPI
Rebecca Moreno, LCPC
- Professional Counselor
- Moline, IL
National Provider Identifier
1104216704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.008375
- Practice address
- 3919 16TH St
Moline, IL 61265-7217 - Phone
- (309) 797-6983
- NPI assigned
- Feb 3, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | |||
| Professional Counselor | 101YP2500X | 180.008375 | IL | Primary |
Addresses
Primary practice location
3919 16TH St
Moline, IL 61265-7217
Mailing address
2560 24TH St Ste 101
Rock Island, IL 61201-5389
Phone (309) 779-3970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 19, 2024 through Jan 19, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.008375 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523923200000",
"number": "1104216704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2560 24TH ST STE 101",
"city": "ROCK ISLAND",
"state": "IL",
"postal_code": "612015389",
"telephone_number": "309-779-3970",
"fax_number": "309-779-2159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3919 16TH ST",
"city": "MOLINE",
"state": "IL",
"postal_code": "612657217",
"telephone_number": "309-797-6983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "REBECCA",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-03",
"last_updated": "2018-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.008375",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moline, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.