Provider Demographics
NPI:1629199781
Name:ENRIGHT-SMITH, SHANNON (LISW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:ENRIGHT-SMITH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LOS ALAMITOS DR
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7701
Mailing Address - Country:US
Mailing Address - Phone:505-280-5860
Mailing Address - Fax:
Practice Address - Street 1:9301 INDIAN SCHOOL RD NE STE 103
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2861
Practice Address - Country:US
Practice Address - Phone:505-280-5860
Practice Address - Fax:505-294-3904
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-068581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical