Healthcare Provider Details

I. General information

NPI: 1184467151
Provider Name (Legal Business Name): LUIS ESQUILIN JR. LMSW, MSSW, BS, BLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 NEW HAVEN AVE
FAR ROCKAWAY NY
11691-5148
US

IV. Provider business mailing address

768 BRADY AVE APT 143
BRONX NY
10462-2770
US

V. Phone/Fax

Practice location:
  • Phone: 929-535-7575
  • Fax: 929-535-7576
Mailing address:
  • Phone: 347-661-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number073458-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: