Healthcare Provider Details

I. General information

NPI: 1689810657
Provider Name (Legal Business Name): ANTHONY ROBERT ESPOSITO LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W MERRICK RD
FREEPORT NY
11520-3826
US

IV. Provider business mailing address

3647 REGENT LN
WANTAGH NY
11793-1431
US

V. Phone/Fax

Practice location:
  • Phone: 516-868-3030
  • Fax:
Mailing address:
  • Phone: 516-465-2075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number056961-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: