Provider Demographics
NPI:1003125592
Name:ESCOBAR, MARTHA CATALINA (TSLD-MSED)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:CATALINA
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:TSLD-MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 ENGERT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4727
Mailing Address - Country:US
Mailing Address - Phone:646-359-3057
Mailing Address - Fax:
Practice Address - Street 1:143 ENGERT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4727
Practice Address - Country:US
Practice Address - Phone:646-359-3057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2083830812355S0801X
NY204499081390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program