Healthcare Provider Details

I. General information

NPI: 1982905642
Provider Name (Legal Business Name): SERENA ESPARRA LCSW, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BROADWAY SUITE 1701
NEW YORK NY
10038-4381
US

IV. Provider business mailing address

147 MIDDLETOWN LINCROFT RD
LINCROFT NJ
07738-1513
US

V. Phone/Fax

Practice location:
  • Phone: 212-732-5427
  • Fax:
Mailing address:
  • Phone: 732-747-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73073373
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: