Provider Demographics
NPI:1386737971
Name:ESPOSITO, EDWARD M SR (LCSW)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:M
Last Name:ESPOSITO
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BRANT AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066
Mailing Address - Country:US
Mailing Address - Phone:732-239-4420
Mailing Address - Fax:732-680-0513
Practice Address - Street 1:17 BRANT AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066
Practice Address - Country:US
Practice Address - Phone:732-239-4420
Practice Address - Fax:732-680-0513
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2024-12-31
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2018-02-06
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048782001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223217692OtherTAX IDENTIFICATION
NJP2544801OtherOXFORD PROVIDER NO.
NH272423OtherMHN PROVIDER NO.
NH354590000OtherMAGELLAN PROVIDER NO.
NJ099872OtherCOMPSYCH PROVIDER NO.