Provider Demographics
NPI:1396080180
Name:ESCOBAR, EKATERINA VASILIEVNA (MS, LPC)
Entity type:Individual
Prefix:
First Name:EKATERINA
Middle Name:VASILIEVNA
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7687 RED BUD TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-1250
Mailing Address - Country:US
Mailing Address - Phone:562-852-5661
Mailing Address - Fax:
Practice Address - Street 1:3939 W RIDGE RD STE A204
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1884
Practice Address - Country:US
Practice Address - Phone:562-852-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008754101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional