Provider Demographics
NPI:1609013119
Name:ENE, MICHAELA (PHD)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:
Last Name:ENE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WASHINGTON ST SUITE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:32103
Mailing Address - Country:US
Mailing Address - Phone:619-297-5437
Mailing Address - Fax:619-297-4567
Practice Address - Street 1:550 WASHINGTON ST SUITE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-297-5437
Practice Address - Fax:619-297-4567
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17703103TC0700X
CA17703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical