Provider Demographics
NPI:1174043368
Name:ESBERG, JOHN ALEXIS (MASTER SOCIAL WORKER)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALEXIS
Last Name:ESBERG
Suffix:
Gender:M
Credentials:MASTER SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:R13 CALLE MARINA
Mailing Address - Street 2:URB DORADO DEL MAR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-485-1405
Mailing Address - Fax:
Practice Address - Street 1:R13 CALLE MARINA
Practice Address - Street 2:URB. DORADO DEL MAR
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-485-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9642104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker