Active NPI
Maricela Ibeth Moreno
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1902455587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW122270
- Practice address
- 3303 N Broadway
Los Angeles, CA 90031-2803 - Phone
- (323) 478-8200
- NPI assigned
- Sep 6, 2019
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CA | ||
| Mental Health Counselor | 101YM0800X | ACSW102897 | CA | |
| Clinical Social Worker | 1041C0700X | ASW102897 | CA | |
| Clinical Social Worker | 1041C0700X | LCSW122270 | CA | Primary |
Addresses
Primary practice location
3303 N Broadway
Los Angeles, CA 90031-2803
Mailing address
3303 N Broadway
Los Angeles, CA 90031-2803
Phone (323) 478-8200
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
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
5321 Via Marisol
Los Angeles, CA 90042-4883
Phone (323) 478-8200
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ACSW102897 | CA | MD | Mental Health Counselor |
| ASW102897 | CA | MD | Clinical Social Worker |
| LCSW122270 | CA | MD | Clinical Social Worker |
| 122270 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Los Angeles County Department of Mental Health | Current | Accepting new patients | |
| Los Angeles County Department of Mental Health | Current | Accepting new patients |
Locations
5321 Via Marisol
Los Angeles, CA 90042
Phone (323) 474-6393
510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416
Organizations & group practices 3
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Los Angeles, CA
- NPI 1083633929
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Los Angeles, CA
- NPI 1558581389
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Arcadia, CA
- NPI 1902676075
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714608000000",
"number": "1902455587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3303 N BROADWAY",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900312803",
"telephone_number": "323-478-8200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3303 N BROADWAY",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900312803",
"telephone_number": "323-478-8200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "MARICELA",
"middle_name": "IBETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-06",
"last_updated": "2024-05-02",
"certification_date": "2024-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "ACSW102897",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "ASW102897",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW122270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; 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.