Provider Demographics
NPI:1841681301
Name:ESSER, MARIETA B (ASSISTANT)
Entity type:Individual
Prefix:
First Name:MARIETA
Middle Name:B
Last Name:ESSER
Suffix:
Gender:F
Credentials:ASSISTANT
Other - Prefix:MRS
Other - First Name:MARIETA
Other - Middle Name:BONTA DE
Other - Last Name:ESSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4014
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91503-4014
Mailing Address - Country:US
Mailing Address - Phone:954-254-2041
Mailing Address - Fax:
Practice Address - Street 1:7541 SECURITY AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-1030
Practice Address - Country:US
Practice Address - Phone:954-254-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ529101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor