Provider Demographics
NPI:1790387744
Name:ENEMARK, MINJI NG (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MINJI
Middle Name:NG
Last Name:ENEMARK
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 1:269 KELTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4652
Mailing Address - Country:US
Mailing Address - Phone:650-380-0894
Mailing Address - Fax:
Practice Address - Street 1:269 KELTON AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4652
Practice Address - Country:US
Practice Address - Phone:650-380-0894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical