Healthcare Provider Details

I. General information

NPI: 1568184653
Provider Name (Legal Business Name): MICHAEL ESPINOZA LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 PATCHEN AVE APT 2L
BROOKLYN NY
11221-2852
US

IV. Provider business mailing address

148 PATCHEN AVE APT 2L
BROOKLYN NY
11221-2852
US

V. Phone/Fax

Practice location:
  • Phone: 347-208-4708
  • Fax:
Mailing address:
  • Phone: 347-208-4708
  • 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: