Provider Demographics
NPI:1013385988
Name:ENCISO, CARMEN EDNA
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:EDNA
Last Name:ENCISO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CARMEN
Other - Middle Name:EDNA
Other - Last Name:ENCISO-STEINBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2373 JANE LN
Mailing Address - Street 2:RENGSTORFF
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-2756
Mailing Address - Country:US
Mailing Address - Phone:650-804-5180
Mailing Address - Fax:
Practice Address - Street 1:2373 JANE LN
Practice Address - Street 2:RENGSTORFF
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-2756
Practice Address - Country:US
Practice Address - Phone:650-804-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT87935106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist