Provider Demographics
NPI:1972662153
Name:MEHL, ENRIQUE J (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:J
Last Name:MEHL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 82ND ST
Mailing Address - Street 2:SUITE 232
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7032
Mailing Address - Country:US
Mailing Address - Phone:718-396-6766
Mailing Address - Fax:718-396-6645
Practice Address - Street 1:3712 82ND ST
Practice Address - Street 2:SUITE 232
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7032
Practice Address - Country:US
Practice Address - Phone:718-396-6766
Practice Address - Fax:718-396-6645
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066318-1171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator