Provider Demographics
NPI:1659798478
Name:ESCOBAR, DANIELLE (LPC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SPYGLASS CIR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6212
Mailing Address - Country:US
Mailing Address - Phone:860-917-4925
Mailing Address - Fax:
Practice Address - Street 1:111 SPYGLASS CIR
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6212
Practice Address - Country:US
Practice Address - Phone:860-917-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid