Provider Demographics
NPI:1063593259
Name:ESPARZA, CARRIE LEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LEE
Last Name:ESPARZA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:LEE
Other - Last Name:VAN ZANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:4712 E 2ND ST STE 232
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5309
Mailing Address - Country:US
Mailing Address - Phone:213-251-6817
Mailing Address - Fax:213-738-4979
Practice Address - Street 1:550 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1912
Practice Address - Country:US
Practice Address - Phone:213-251-6817
Practice Address - Fax:213-738-4979
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical