Provider Demographics
NPI:1093058729
Name:ESPOSITO, MARLANA B (EDS)
Entity Type:Individual
Prefix:MRS
First Name:MARLANA
Middle Name:B
Last Name:ESPOSITO
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 MOGADORE RD
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-1173
Mailing Address - Country:US
Mailing Address - Phone:330-414-6140
Mailing Address - Fax:
Practice Address - Street 1:3608 MOGADORE RD
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-1173
Practice Address - Country:US
Practice Address - Phone:330-414-6140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 542103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool