Provider Demographics
NPI:1518181643
Name:ENO, ANNE PICKHARDT (EDS)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:PICKHARDT
Last Name:ENO
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22200 109TH DR
Mailing Address - Street 2:
Mailing Address - City:O BRIEN
Mailing Address - State:FL
Mailing Address - Zip Code:32071-2610
Mailing Address - Country:US
Mailing Address - Phone:386-935-0771
Mailing Address - Fax:386-935-0771
Practice Address - Street 1:22200 109TH DR
Practice Address - Street 2:
Practice Address - City:O BRIEN
Practice Address - State:FL
Practice Address - Zip Code:32071-2610
Practice Address - Country:US
Practice Address - Phone:386-935-0771
Practice Address - Fax:386-935-0771
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS821103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool