Provider Demographics
NPI:1912229311
Name:ESTERBURG, TODD J (LISW)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:J
Last Name:ESTERBURG
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20033 DETROIT RD STE G
Mailing Address - Street 2:NORTH RIDGE ANNEX
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2400
Mailing Address - Country:US
Mailing Address - Phone:216-224-9230
Mailing Address - Fax:
Practice Address - Street 1:20033 DETROIT RD STE G
Practice Address - Street 2:NORTH RIDGE ANNEX
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-2400
Practice Address - Country:US
Practice Address - Phone:216-224-9230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.11012551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0172967Medicaid