Provider Demographics
NPI:1821439662
Name:ESPEJO, KAROL (LCSW-C)
Entity type:Individual
Prefix:
First Name:KAROL
Middle Name:
Last Name:ESPEJO
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 CHANGEBRIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9839
Mailing Address - Country:US
Mailing Address - Phone:240-242-7640
Mailing Address - Fax:
Practice Address - Street 1:330 CHANGEBRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9839
Practice Address - Country:US
Practice Address - Phone:240-464-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD190181041C0700X
NY0939501041C0700X
NJ44SC061051001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1821439662OtherSELF-EMPLOYED