Healthcare Provider Details

I. General information

NPI: 1205763646
Provider Name (Legal Business Name): MARY CAROLINE ESHUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 WARD ST APT 2
WORCESTER MA
01610-3580
US

IV. Provider business mailing address

83 WARD ST APT 2
WORCESTER MA
01610-3580
US

V. Phone/Fax

Practice location:
  • Phone: 860-477-6742
  • Fax:
Mailing address:
  • Phone: 860-477-6742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: