Healthcare Provider Details

I. General information

NPI: 1295104099
Provider Name (Legal Business Name): ESMERALDA BARRERA KOVACH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ESMERALDA BARRERA-KOVACH

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UTMB DEPT OF FAMILY MEDICINE 400 HARBORSIDE
GALVESTON TX
77555-0001
US

IV. Provider business mailing address

UTMB DEPT OF FAMILY MEDICINE 400 HARBORSIDE
GALVESTON TX
77555-0001
US

V. Phone/Fax

Practice location:
  • Phone: 409-747-8964
  • Fax: 409-772-2663
Mailing address:
  • Phone: 409-747-8964
  • Fax: 409-772-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26358
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: