Provider Demographics
NPI:1164778874
Name:ENRIQUEZ, YASNIEL (MBA, MSW, CBHCMS)
Entity Type:Individual
Prefix:MR
First Name:YASNIEL
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:MBA, MSW, CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14241 SW 296TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3009
Mailing Address - Country:US
Mailing Address - Phone:786-255-7333
Mailing Address - Fax:305-248-3499
Practice Address - Street 1:654 NE 9TH PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4934
Practice Address - Country:US
Practice Address - Phone:305-248-3488
Practice Address - Fax:305-248-3499
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLCBHCMS.0100116171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012968200Medicaid
FLCBHCMS.0100116OtherFLORIDA CERTIFICATION BOARD