Healthcare Provider Details

I. General information

NPI: 1487858007
Provider Name (Legal Business Name): CRISTINA B ESCOBAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 SWISS AVE
DALLAS TX
75204-6245
US

IV. Provider business mailing address

1412-22 FAIRMOUNT AVENUE
PHILADELPHIA PA
19130-2908
US

V. Phone/Fax

Practice location:
  • Phone: 214-818-2634
  • Fax:
Mailing address:
  • Phone: 215-684-5344
  • Fax: 215-232-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS38799
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: