Healthcare Provider Details

I. General information

NPI: 1689808081
Provider Name (Legal Business Name): HELEN ESANBOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 ARDMORE RD
NORTH BALDWIN NY
11510-1503
US

IV. Provider business mailing address

1068 ARDMORE RD
NORTH BALDWIN NY
11510-1503
US

V. Phone/Fax

Practice location:
  • Phone: 516-670-6068
  • Fax: 516-608-4065
Mailing address:
  • Phone: 516-670-6068
  • Fax: 516-608-4065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR056953-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: