Active NPI
Omar Moreno, LCP
- Professional Counselor
- Cicero, IL
National Provider Identifier
1982150140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 1441 S 61St CT
Cicero, IL 60804-1049 - Phone
- (224) 432-9196
- NPI assigned
- Aug 28, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | Primary |
Addresses
Primary practice location
1441 S 61St CT
Cicero, IL 60804-1049
Mailing address
PO Box 1553
Deerfield, IL 60015-6009
Phone (224) 432-9196
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 199960618 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472342400000",
"number": "1982150140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1553",
"city": "DEERFIELD",
"state": "IL",
"postal_code": "600156009",
"telephone_number": "224-432-9196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1441 S 61ST CT",
"city": "CICERO",
"state": "IL",
"postal_code": "608041049",
"telephone_number": "224-432-9196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "OMAR",
"credential": "LCP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-08-28",
"last_updated": "2016-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "199960618",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cicero, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.