Provider Demographics
NPI:1730854019
Name:ESPINOSA, NICOLE ANN (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:BRAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:565 CHANEY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2722
Mailing Address - Country:US
Mailing Address - Phone:951-253-7130
Mailing Address - Fax:
Practice Address - Street 1:565 CHANEY ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2722
Practice Address - Country:US
Practice Address - Phone:951-253-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA658491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical