Provider Demographics
NPI:1558025163
Name:ACOSTA ESCORCIA, JORGE ISRAEL
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ISRAEL
Last Name:ACOSTA ESCORCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 NORMAN ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-5003
Mailing Address - Country:US
Mailing Address - Phone:413-296-6185
Mailing Address - Fax:413-732-5362
Practice Address - Street 1:85 SAINT GEORGE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3333
Practice Address - Country:US
Practice Address - Phone:413-732-2120
Practice Address - Fax:413-732-5362
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor