Healthcare Provider Details

I. General information

NPI: 1366278582
Provider Name (Legal Business Name): CATHERINE ELIZABETH ESPERANZA MA, QMHP-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 S MACADAM AVE STE 350
PORTLAND OR
97239-3877
US

IV. Provider business mailing address

3750 S RIVER PKWY APT 636
PORTLAND OR
97239-4749
US

V. Phone/Fax

Practice location:
  • Phone: 503-231-7854
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: