Provider Demographics
NPI:1033524657
Name:ENANG, JULIUS
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:
Last Name:ENANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 GEORGETOWNE DR
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1056
Mailing Address - Country:US
Mailing Address - Phone:781-492-6408
Mailing Address - Fax:
Practice Address - Street 1:400 WASHINGTON ST STE 303
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4768
Practice Address - Country:US
Practice Address - Phone:781-492-6408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health