Provider Demographics
NPI:1962939447
Name:ESTEBAN, HEATHER MARIE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:ESTEBAN
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 1:255 LAKE SEMINARY CIR
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3354
Mailing Address - Country:US
Mailing Address - Phone:407-427-6882
Mailing Address - Fax:407-650-3328
Practice Address - Street 1:231 W BAY AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4125
Practice Address - Country:US
Practice Address - Phone:321-872-8032
Practice Address - Fax:321-285-4950
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health