Provider Demographics
NPI:1922190206
Name:ENLOW, WILLIAM ROBERT (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:ENLOW
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 BANK PL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46231-5227
Mailing Address - Country:US
Mailing Address - Phone:317-246-7460
Mailing Address - Fax:
Practice Address - Street 1:6655 E US 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8923
Practice Address - Country:US
Practice Address - Phone:317-272-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005104A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000492127OtherANTHEM BCBS PROVIDER PIN
IN000000492127OtherANTHEM BCBS PROVIDER PIN