Healthcare Provider Details

I. General information

NPI: 1932091238
Provider Name (Legal Business Name): INES MARIA ESCUDERO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CARDINAL LN
WILTON CT
06897-4105
US

IV. Provider business mailing address

6 CARDINAL LN
WILTON CT
06897-4105
US

V. Phone/Fax

Practice location:
  • Phone: 646-717-4149
  • Fax:
Mailing address:
  • Phone: 646-717-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8632
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: