Healthcare Provider Details

I. General information

NPI: 1578173118
Provider Name (Legal Business Name): JESSICA MARIE ESPOSITO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 MAMARONECK AVE STE 202
MAMARONECK NY
10543-1661
US

IV. Provider business mailing address

933 MAMARONECK AVE STE 202
MAMARONECK NY
10543-1661
US

V. Phone/Fax

Practice location:
  • Phone: 914-361-9571
  • Fax:
Mailing address:
  • Phone: 914-361-9571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109866
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number096841
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number096841
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: