Provider Demographics
NPI:1811174220
Name:ESBJORN, VIPASSANA CHRISTINE
Entity type:Individual
Prefix:DR
First Name:VIPASSANA
Middle Name:CHRISTINE
Last Name:ESBJORN
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 1:2318 CARSON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8901
Mailing Address - Country:US
Mailing Address - Phone:415-279-5632
Mailing Address - Fax:
Practice Address - Street 1:7151 WILTON AVE
Practice Address - Street 2:STE 201
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3756
Practice Address - Country:US
Practice Address - Phone:707-823-1400
Practice Address - Fax:707-823-1407
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20879103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical