=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942836390
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNY MARY ESPARZA LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2020
-----------------------------------------------------
Last Update Date | 03/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2043 CHEVELLA DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75232-4159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-734-5062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2043 CHEVELLA DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75232-4159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-734-5062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 61317
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------