Healthcare Provider Details

I. General information

NPI: 1952534877
Provider Name (Legal Business Name): ERICA DAWN T ESCALANTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 CHALAN PALOSYO
AGANA HEIGHTS GU
96910-6427
US

IV. Provider business mailing address

498 CHALAN PALAYSO
AGANA HEIGHTS GUAM
96910
UM

V. Phone/Fax

Practice location:
  • Phone: 671-475-5760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number56706
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number56706
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: