Provider Demographics
NPI:1003605270
Name:ESCOBAR, ASHLEY (LAC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 VILLAGE GRN APT M
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-1344
Mailing Address - Country:US
Mailing Address - Phone:908-396-6056
Mailing Address - Fax:
Practice Address - Street 1:590 N 7TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-4553
Practice Address - Country:US
Practice Address - Phone:973-596-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00676100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health