Jesus Moreno
Individual provider Active NPI Clinical Social Worker · Salt Lake City, UT
NPI 1205629656 · NPPES record last updated May 28, 2025
Key facts
- NPI
- 1205629656
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 8710926-3502 (UT)
- Practice address
- 117 W 400 S
Salt Lake City, UT 84101-1916 - Phone
- (801) 428-4257
- NPI assigned
- May 28, 2025
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8710926-3502 | UT | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 8710926-3502 | UT | Yes |
Addresses
Primary practice location
117 W 400 S
Salt Lake City, UT 84101-1916
Mailing address
117 W 400 S
Salt Lake City, UT 84101-1916
Phone (801) 428-4257
NPI Registry JSON
{
"created_epoch": "1748390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748390400000",
"number": "1205629656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 W 400 S",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841011916",
"telephone_number": "801-428-4257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 W 400 S",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841011916",
"telephone_number": "801-428-4257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "JESUS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-05-28",
"last_updated": "2025-05-28",
"certification_date": "2025-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "8710926-3502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
- Debora de Almeida Simoes Moreira
- Celeste L Moreland
- Daniel James Moreland
- Kristina Morell
- Alejandro Moreno
- Luis Norberto Moreno
- Maria Moreno
- Sherry Michelle Moreno
- Sophia Allison Moreno
- Vanessa Moreno
All providers in Salt Lake City, UT · Clinical Social Worker in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.