Provider Demographics
NPI:1528808540
Name:ESCOBAR, JANELL ALEXA
Entity type:Individual
Prefix:
First Name:JANELL
Middle Name:ALEXA
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WESTSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927-1131
Mailing Address - Country:US
Mailing Address - Phone:845-630-7955
Mailing Address - Fax:
Practice Address - Street 1:22 WESTSIDE AVE
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-1131
Practice Address - Country:US
Practice Address - Phone:845-630-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool