Provider Demographics
NPI:1942287503
Name:ENOCH, LOUISE P (PHD)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:P
Last Name:ENOCH
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 1:58 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1904
Mailing Address - Country:US
Mailing Address - Phone:617-926-0836
Mailing Address - Fax:
Practice Address - Street 1:985 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5434
Practice Address - Country:US
Practice Address - Phone:781-848-5674
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1168OtherBLUE CROSS BLUE SHIELD
MAPO1168OtherBLUE CROSS BLUE SHIELD