Healthcare Provider Details

I. General information

NPI: 1568616969
Provider Name (Legal Business Name): JOANNA ESCOBAR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 GOODRICH ST
UNIONDALE NY
11553-2406
US

IV. Provider business mailing address

858 GOODRICH ST
UNIONDALE NY
11553-2406
US

V. Phone/Fax

Practice location:
  • Phone: 516-314-5218
  • Fax:
Mailing address:
  • Phone: 516-314-5218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number056796-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: