Healthcare Provider Details

I. General information

NPI: 1093058729
Provider Name (Legal Business Name): MARLANA B ESPOSITO ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 MOGADORE RD
MOGADORE OH
44260-1173
US

IV. Provider business mailing address

3608 MOGADORE RD
MOGADORE OH
44260-1173
US

V. Phone/Fax

Practice location:
  • Phone: 330-414-6140
  • Fax:
Mailing address:
  • Phone: 330-414-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP 542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: