Healthcare Provider Details

I. General information

NPI: 1487759189
Provider Name (Legal Business Name): ANNA ESCAMILLA LCSW, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11673 JOLLYVILLE RD SUITE 204
AUSTIN TX
78759-3933
US

IV. Provider business mailing address

11673 JOLLYVILLE RD SUITE 204
AUSTIN TX
78759-3933
US

V. Phone/Fax

Practice location:
  • Phone: 512-401-0002
  • Fax: 512-401-0006
Mailing address:
  • Phone: 512-401-0002
  • Fax: 512-401-0006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number02797
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: