Healthcare Provider Details

I. General information

NPI: 1821507104
Provider Name (Legal Business Name): ESMA ZAGORICA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 GENESEE ST
UTICA NY
13501-5930
US

IV. Provider business mailing address

2209 GENESEE STREET BUSINESS OFFICE ROOM 310
UTICA NY
13501-5930
US

V. Phone/Fax

Practice location:
  • Phone: 315-801-3355
  • Fax: 315-801-8352
Mailing address:
  • Phone: 315-801-3282
  • Fax: 315-801-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101797
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: