Healthcare Provider Details

I. General information

NPI: 1205446853
Provider Name (Legal Business Name): MARIA J ESCOBAR MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HWY 224
ESTACADA OR
97023
US

IV. Provider business mailing address

1200 SW 27TH ST
RENTON WA
98057-2603
US

V. Phone/Fax

Practice location:
  • Phone: 503-630-5511
  • Fax:
Mailing address:
  • Phone: 800-287-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60551672
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: