Healthcare Provider Details

I. General information

NPI: 1295823326
Provider Name (Legal Business Name): ELISABETH A ESPOSITO LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S EDWIN C MOSES BLVD
DAYTON OH
45417-3424
US

IV. Provider business mailing address

601 S EDWIN C MOSES BLVD
DAYTON OH
45417-3424
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-8333
  • Fax: 765-983-8609
Mailing address:
  • Phone: 937-734-8333
  • Fax: 765-983-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number39000668A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-0002638
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: