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General NPI Number Information
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NPI Number | 1578871539
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Entity Type | Individual
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Provider Name | MRS. CHANTAL FONG ESPERT
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Gender | Female
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 1119 CARLL'S STRAIGHT PATH
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City | DIX HILLS
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State | NY
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Zip | 11746
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Country | US
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Telephone | 631-254-0680
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Fax | 516-742-0696
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Provider Business Mailing Address
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Address Line | 1119 CARLLS STRAIGHT PATH
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City | DIX HILLS
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State | NY
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Zip | 11746-8013
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Country | US
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Telephone | 631-254-0680
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Fax | 516-742-0696
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 070303
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License Number State | NY
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