Healthcare Provider Details

I. General information

NPI: 1174966527
Provider Name (Legal Business Name): TRISHA KRISTINE ESPINOZA M.A, ED.S., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 MOUNTAIN BLVD
WATCHUNG NJ
07069-6269
US

IV. Provider business mailing address

942 HAMILTON ST
RAHWAY NJ
07065-2711
US

V. Phone/Fax

Practice location:
  • Phone: 732-669-7245
  • Fax:
Mailing address:
  • Phone: 732-669-7245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00439700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: