Provider Demographics
NPI:1265900187
Name:DI CENSO, ENRICO MICHAEL JR (LADC II)
Entity type:Individual
Prefix:MR
First Name:ENRICO
Middle Name:MICHAEL
Last Name:DI CENSO
Suffix:JR
Gender:M
Credentials:LADC II
Other - Prefix:MR
Other - First Name:ENRICO
Other - Middle Name:MICHAEL
Other - Last Name:DI CENSO
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:36 CHILMARK DR
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5167
Mailing Address - Country:US
Mailing Address - Phone:857-205-6675
Mailing Address - Fax:
Practice Address - Street 1:470 MAIN ST
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-2047
Practice Address - Country:US
Practice Address - Phone:508-760-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health