Provider Demographics
NPI:1427222363
Name:ESCOBAR, MARLO
Entity type:Individual
Prefix:
First Name:MARLO
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARLO
Other - Middle Name:
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:871 OLD ALICE RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8268
Mailing Address - Country:US
Mailing Address - Phone:956-542-7587
Mailing Address - Fax:956-542-7597
Practice Address - Street 1:871 OLD ALICE RD
Practice Address - Street 2:SUITE 600
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8268
Practice Address - Country:US
Practice Address - Phone:956-542-7587
Practice Address - Fax:956-542-7597
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40316104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40316OtherSTATE LICENSE