Provider Demographics
NPI:1275983991
Name:ESPANO, JOSHUA BERGONIA (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BERGONIA
Last Name:ESPANO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SO. LAFAYETTE PARK PLACE 5TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-252-2100
Mailing Address - Fax:213-383-3146
Practice Address - Street 1:520 SO. LAFAYETTE PARK PLACE 5TH FLOOR
Practice Address - Street 2:
Practice Address - City:LA
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-252-2100
Practice Address - Fax:213-383-3146
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW71927101YM0800X
171M00000X
CA925941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator