Healthcare Provider Details

I. General information

NPI: 1740106947
Provider Name (Legal Business Name): JENNIFER ELIZABETH ESCOBAR MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 UNIVERSITY BLVD E STE 245
HYATTSVILLE MD
20783-4646
US

IV. Provider business mailing address

1425 UNIVERSITY BLVD E STE 245
HYATTSVILLE MD
20783-4646
US

V. Phone/Fax

Practice location:
  • Phone: 240-752-2767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP15505
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: