Provider Demographics
NPI:1275027666
Name:ENQUIST, VICTORIA ANNE HODGE (LCSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNE HODGE
Last Name:ENQUIST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06779-2133
Mailing Address - Country:US
Mailing Address - Phone:203-910-9930
Mailing Address - Fax:
Practice Address - Street 1:420 HIGHLAND AVE STE B1
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2527
Practice Address - Country:US
Practice Address - Phone:203-718-6318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0110511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical