Provider Demographics
NPI:1952847931
Name:DR. KATHRYN ESQUER, LLC
Entity type:Organization
Organization Name:DR. KATHRYN ESQUER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESQUER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:570-259-0168
Mailing Address - Street 1:65 FAIRWAY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2632
Mailing Address - Country:US
Mailing Address - Phone:570-259-0168
Mailing Address - Fax:
Practice Address - Street 1:65 FAIRWAY LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2632
Practice Address - Country:US
Practice Address - Phone:570-259-0168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9690103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty