Provider Demographics
NPI:1841804739
Name:ESCOBAR, INGRID ESTHER
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:ESTHER
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 SE 25TH ST UNIT 208
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-2480
Mailing Address - Country:US
Mailing Address - Phone:786-399-1587
Mailing Address - Fax:
Practice Address - Street 1:1543 SE 25TH ST UNIT 208
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-2480
Practice Address - Country:US
Practice Address - Phone:786-399-1587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-121342106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician