Provider Demographics
NPI:1326750407
Name:ENRIQUEZ, AMBER (LCSW, C-ACYFSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:LCSW, C-ACYFSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N ESTRELLA PKWY STE B2-272
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-4135
Mailing Address - Country:US
Mailing Address - Phone:602-699-6171
Mailing Address - Fax:833-474-1228
Practice Address - Street 1:500 N ESTRELLA PKWY STE B2-272
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-4135
Practice Address - Country:US
Practice Address - Phone:602-699-6171
Practice Address - Fax:833-474-1228
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical