Provider Demographics
NPI:1396515896
Name:ENCISO, LIELLA MARIE
Entity type:Individual
Prefix:
First Name:LIELLA
Middle Name:MARIE
Last Name:ENCISO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3204
Mailing Address - Country:US
Mailing Address - Phone:317-565-3777
Mailing Address - Fax:
Practice Address - Street 1:1520 E 72ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3204
Practice Address - Country:US
Practice Address - Phone:317-565-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker