Healthcare Provider Details

I. General information

NPI: 1427310283
Provider Name (Legal Business Name): YOLANDA ESQUICHE L.C.A.D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 MARKET ST SUITE 217
PATERSON NJ
07505-1724
US

IV. Provider business mailing address

258 FAIRVIEW AVE
PROSPECT PARK NJ
07508-1834
US

V. Phone/Fax

Practice location:
  • Phone: 973-980-5013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00076300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: