Provider Demographics
NPI:1497394308
Name:ESPINOSA, MARY (LMSW,LPN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:LMSW,LPN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:ESPINOSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW,LPN
Mailing Address - Street 1:344 ROSEDOWN DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3326
Mailing Address - Country:US
Mailing Address - Phone:504-421-7538
Mailing Address - Fax:
Practice Address - Street 1:128 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5939
Practice Address - Country:US
Practice Address - Phone:985-651-3777
Practice Address - Fax:985-651-3770
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12916104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker