Healthcare Provider Details

I. General information

NPI: 1124376371
Provider Name (Legal Business Name): ESPERANZA PARA FAMILIAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E 66TH ST STE B103
RICHFIELD MN
55423-4577
US

IV. Provider business mailing address

1313 E 66TH ST STE B103
RICHFIELD MN
55423-4577
US

V. Phone/Fax

Practice location:
  • Phone: 952-854-1239
  • Fax: 952-843-5663
Mailing address:
  • Phone: 952-854-1239
  • Fax: 952-843-5663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18130
License Number StateMN

VIII. Authorized Official

Name: MISS EUGENIA TEODOCIA APAZA-COAQUIRA
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LICSW
Phone: 952-854-1239