Provider Demographics
NPI:1831417096
Name:SOTO, LAWRENCE (LARRY) ESTABAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE (LARRY)
Middle Name:ESTABAN
Last Name:SOTO
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 1:3492 LOES WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-3437
Mailing Address - Country:US
Mailing Address - Phone:408-464-6709
Mailing Address - Fax:
Practice Address - Street 1:1777 HAMILTON AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5430
Practice Address - Country:US
Practice Address - Phone:408-464-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 12859101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health