Provider Demographics
NPI:1134285612
Name:ESPERICUETA, DALIA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DALIA
Middle Name:S
Last Name:ESPERICUETA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-1374
Mailing Address - Country:US
Mailing Address - Phone:903-874-7133
Mailing Address - Fax:903-874-1495
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-5215
Practice Address - Country:US
Practice Address - Phone:903-874-7133
Practice Address - Fax:903-874-1495
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0097EFOtherBCBS
TX128001OtherVALUE OPTIONS
TXS87574Medicare UPIN
TX128001OtherVALUE OPTIONS