Provider Demographics
NPI:1447366992
Name:ESPOSITO, ELEANOR CAROLINE (MA)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:CAROLINE
Last Name:ESPOSITO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4498
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26504-4498
Mailing Address - Country:US
Mailing Address - Phone:304-599-5073
Mailing Address - Fax:304-599-1955
Practice Address - Street 1:630 VISTA PLACES
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-599-5073
Practice Address - Fax:304-599-1955
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV507103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV254877OtherMAMSI- OPTIMUM CHOICE
WV125311OtherCOMP PSYCH
WV4293745OtherAETNA
WV5506874997217OtherCOMMUNITY INS, COMPANY
WVY038438OtherTHP
WV125311OtherMAGELLAN
WV9201029000Medicaid
WV061429OtherVALUEOPTIONS
WV12380OtherMENTAL HEALTH NETWORK
WV254877OtherCIGNA BEHAVIORAL HEALTH
WV12380OtherMENTAL HEALTH NETWORK
WV061429OtherVALUEOPTIONS
WV0684921Medicare PIN