Healthcare Provider Details

I. General information

NPI: 1841913043
Provider Name (Legal Business Name): YANIRA ESCAMILLA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8517 214TH ST
QUEENS VILLAGE NY
11427-1344
US

IV. Provider business mailing address

8517 214TH ST
QUEENS VILLAGE NY
11427-1344
US

V. Phone/Fax

Practice location:
  • Phone: 347-498-3274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number091410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: