Provider Demographics
NPI:1023183514
Name:DEURQUIZA, ENRIQUE FELIX (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:FELIX
Last Name:DEURQUIZA
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4315
Mailing Address - Country:US
Mailing Address - Phone:718-524-8290
Mailing Address - Fax:
Practice Address - Street 1:39 GENESEE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4315
Practice Address - Country:US
Practice Address - Phone:718-524-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0409941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN06651Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORK