Mary Ellen Moreno, BA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

101YM0800X Issued in FL

Practice address

6266 Dupont Station CT E
Jacksonville, FL 32217-2567

Phone

(904) 745-0067

Fax

(904) 745-1030

NPI assigned

Sep 27, 2012

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

State licenses

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

{
    "created_epoch": "1348704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1811248008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6266 DUPONT STATION CT E",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322172567",
            "telephone_number": "904-745-0067",
            "fax_number": "904-745-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6266 DUPONT STATION CT E",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322172567",
            "telephone_number": "904-745-0067",
            "fax_number": "904-745-1030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "259 Bill France Blvd",
            "address_purpose": "LOCATION",
            "city": "Daytona Beach",
            "state": "FL",
            "postal_code": "321141316",
            "country_code": "US",
            "telephone_number": "386-868-1992",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORENO",
        "first_name": "MARY ELLEN",
        "name_prefix": "Ms.",
        "credential": "BA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-27",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "101YM0800X",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "FL",
            "license": "M650540586680",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Moreno-Lackman, ARNP
• Anita Moreno, LISW
• Fernando Moreno Jr., MD
• Jessica Christine Moreno, LMHC
• John Paul Moreno, PC
• Raul J Moreno, MD
• Tomas Alejandro Moreno, MD
• Yessenia Franco Moreno, LCSW
• Jessica Natalie Morenus, APRN
• Chelsey Morera

• Mental Health Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.