Provider Demographics
NPI:1780780346
Name:ESPITIA, JUAN DANIEL (LCSW)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:DANIEL
Last Name:ESPITIA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 S NAPLES AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-5030
Mailing Address - Country:US
Mailing Address - Phone:928-261-6759
Mailing Address - Fax:928-336-1619
Practice Address - Street 1:1414 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4608
Practice Address - Country:US
Practice Address - Phone:928-261-6759
Practice Address - Fax:928-336-1619
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 229141041C0700X
AZLCSW-28561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical