Provider Demographics
NPI:1013291376
Name:ESNIL, EDNA MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:MARIE
Last Name:ESNIL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 OAK GROVE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4441
Mailing Address - Country:US
Mailing Address - Phone:650-255-2679
Mailing Address - Fax:
Practice Address - Street 1:885 OAK GROVE AVE STE 210
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4441
Practice Address - Country:US
Practice Address - Phone:650-255-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20471103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist