Provider Demographics
NPI:1972359560
Name:MOLDOVAN, ESTERA (LAC)
Entity type:Individual
Prefix:MRS
First Name:ESTERA
Middle Name:
Last Name:MOLDOVAN
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25950 W DEER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-2530
Mailing Address - Country:US
Mailing Address - Phone:480-779-0671
Mailing Address - Fax:
Practice Address - Street 1:15331 W BELL RD STE 4
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4102
Practice Address - Country:US
Practice Address - Phone:951-965-8278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health