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General NPI Number Information
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NPI Number | 1124376371
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Entity Type | Organization
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Legal Business Name | ESPERANZA PARA FAMILIAS LLC
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 1313 E 66TH ST STE B103
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City | RICHFIELD
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State | MN
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Zip | 55423-4577
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Country | US
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Telephone | 952-854-1239
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Fax | 952-843-5663
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Provider Business Mailing Address
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Address Line | 1313 E 66TH ST STE B103
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City | RICHFIELD
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State | MN
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Zip | 55423-4577
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Country | US
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Telephone | 952-854-1239
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Fax | 952-843-5663
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MISS EUGENIA TEODOCIA APAZA-COAQUIRA
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Credential | LICSW
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Telephone | 952-854-1239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 18130
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License Number State | MN
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