Provider Demographics
NPI:1891704052
Name:ENRIQUEZ, ENEDINA ELISA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ENEDINA
Middle Name:ELISA
Last Name:ENRIQUEZ
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 1:908 E FERGUSON ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2614
Mailing Address - Country:US
Mailing Address - Phone:956-342-4354
Mailing Address - Fax:956-602-1272
Practice Address - Street 1:908 E FERGUSON ST
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2614
Practice Address - Country:US
Practice Address - Phone:956-342-4354
Practice Address - Fax:956-602-1271
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28207104100000X, 171W00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178473807Medicaid
TX297246YNG9Medicare PIN