Healthcare Provider Details

I. General information

NPI: 1255739876
Provider Name (Legal Business Name): RANDI LEE ESASKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2014
Last Update Date: 12/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 TENSAW DR
BROWNS MILLS NJ
08015-6638
US

IV. Provider business mailing address

109 TENSAW DR
BROWNS MILLS NJ
08015-6638
US

V. Phone/Fax

Practice location:
  • Phone: 609-893-0378
  • Fax:
Mailing address:
  • Phone: 609-893-0378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: