Irma Elizabeth Moreno Montelongo, PSYD, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

99612 Issued in CA

Practice address

10775 Pioneer TRL Ste 215
Truckee, CA 96161-0234

Phone

(415) 424-4266

Fax

(415) 520-6633

NPI assigned

Sep 16, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

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.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Clinical

  Medicare reassignment NPD

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

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1760715296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10775 PIONEER TRL STE 215",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961610234",
            "telephone_number": "415-424-4266",
            "fax_number": "415-520-6633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10775 PIONEER TRL STE 215",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961610234",
            "telephone_number": "415-424-4266",
            "fax_number": "415-520-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO MONTELONGO",
        "first_name": "IRMA",
        "middle_name": "ELIZABETH",
        "credential": "PSYD, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-16",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "31525",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "99612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicolas Mills, PSYD
• Griffin Mims
• Brionna Miner
• Colby Moats
• Laura Lea Mohun, PT,ATC
• Betty Sue Morgan-Close, R.N., C.R.N.F.A.
• Jonathan C Morgan, PA-C
• Mary Morrison, FNP
• Pachai Susan Moua
• Mountain West Derm California PC

• Clinical Social Worker in Truckee, CA
• Providers in Truckee, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.