Provider Demographics
NPI:1114569548
Name:ENRILLE, STEPHANIE GEORGINE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GEORGINE
Last Name:ENRILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 HIGH POINT CIR APT 2
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-1917
Mailing Address - Country:US
Mailing Address - Phone:813-748-1985
Mailing Address - Fax:
Practice Address - Street 1:8330 HIGH POINT CIR APT 2
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-1917
Practice Address - Country:US
Practice Address - Phone:813-748-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker