Healthcare Provider Details

I. General information

NPI: 1134430952
Provider Name (Legal Business Name): EILEEN JOY E ESPORO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 07/03/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DRIVE
VACAVILLE CA
95696-0205
US

IV. Provider business mailing address

1600 CALIFORNIA DRIVE
VACAVILLE CA
95696-0205
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-6841
  • Fax:
Mailing address:
  • Phone: 707-448-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number71415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: