Healthcare Provider Details

I. General information

NPI: 1649385410
Provider Name (Legal Business Name): MARIANN ESCHENBURG LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 INDEPENDENCE BLVD SUITE 326
VIRGINIA BEACH VA
23462-2986
US

IV. Provider business mailing address

281 INDEPENDENCE BLVD SUITE 326
VIRGINIA BEACH VA
23462-2986
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-0377
  • Fax: 757-497-1327
Mailing address:
  • Phone: 757-490-0377
  • Fax: 757-497-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801078207
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006520
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: