Provider Demographics
NPI:1982986477
Name:ESMARIO, ANTONIA (LMFT)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:ESMARIO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75335 BLUE MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-9490
Mailing Address - Country:US
Mailing Address - Phone:541-942-0199
Mailing Address - Fax:
Practice Address - Street 1:75335 BLUE MOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-9490
Practice Address - Country:US
Practice Address - Phone:541-942-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor