Active NPI
Michelle Moreno, LCSW
- Clinical Social Worker
- Modesto, CA
National Provider Identifier
1710241310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 28058
- Practice address
- 615 13TH St
Suite B
Modesto, CA 95354-2456 - Phone
- (209) 222-3396
- Fax
- (209) 289-0061
- NPI assigned
- Jun 28, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 28058 | CA | Primary |
Addresses
Primary practice location
615 13TH St
Suite B
Modesto, CA 95354-2456
Mailing address
615 13TH St
Suite B
Modesto, CA 95354-2456
Phone (209) 222-3396
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260424002552 | CA | Practitioner - Clinical Social Worker | 6800363029 | Practice locations: Modesto, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
615 13TH St
Suite B
Modesto, CA 95354-2456
Phone (209) 222-3396
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28058 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1775433600000",
"number": "1710241310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 13TH ST",
"address_2": "SUITE B",
"city": "MODESTO",
"state": "CA",
"postal_code": "953542456",
"telephone_number": "209-222-3396",
"fax_number": "209-289-0061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 13TH ST",
"address_2": "SUITE B",
"city": "MODESTO",
"state": "CA",
"postal_code": "953542456",
"telephone_number": "209-222-3396",
"fax_number": "209-289-0061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "MICHELLE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-28",
"last_updated": "2026-04-06",
"certification_date": "2026-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "28058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.