Provider Demographics
NPI:1396706438
Name:ESSIEN, EKERETTE J (PHD)
Entity type:Individual
Prefix:DR
First Name:EKERETTE
Middle Name:J
Last Name:ESSIEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:EKERETTE
Other - Middle Name:JOSEPH
Other - Last Name:ESSIEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:16795 CATALONIA DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-8705
Mailing Address - Country:US
Mailing Address - Phone:909-660-3050
Mailing Address - Fax:888-235-1709
Practice Address - Street 1:6833 INDIANA AVE STE 208
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4223
Practice Address - Country:US
Practice Address - Phone:951-660-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17740103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY177400Medicaid
CACA115184Medicare PIN
CACP17740Medicare PIN