1295104099 NPI number — MS. ESMERALDA BARRERA KOVACH LCSW

Table of content: MS. ESMERALDA BARRERA KOVACH LCSW (NPI 1295104099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295104099 NPI number — MS. ESMERALDA BARRERA KOVACH LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOVACH
Provider First Name:
ESMERALDA
Provider Middle Name:
BARRERA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARRERA-KOVACH
Provider Other First Name:
ESMERALDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1295104099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UTMB DEPT OF FAMILY MEDICINE
Provider Second Line Business Mailing Address:
400 HARBORSIDE
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77555-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-747-8964
Provider Business Mailing Address Fax Number:
409-772-2663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UTMB DEPT OF FAMILY MEDICINE
Provider Second Line Business Practice Location Address:
400 HARBORSIDE
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77555-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-747-8964
Provider Business Practice Location Address Fax Number:
409-772-2663
Provider Enumeration Date:
09/22/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  26358 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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