Provider Demographics
NPI:1851600217
Name:ESQUER, KATHRYN YAVOREK (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:YAVOREK
Last Name:ESQUER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:L
Other - Last Name:YAVOREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:21 SUSQUEHANNA VALLEY MALL DR STE A
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9148
Practice Address - Country:US
Practice Address - Phone:570-374-7852
Practice Address - Fax:570-374-7932
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018333103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034180590001Medicaid
606338F6KOtherMEDICARE