Provider Demographics
NPI:1720164874
Name:ENRIGHT, STEFANIE HALLUM (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:HALLUM
Last Name:ENRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:STEFANIE
Other - Middle Name:JOAN
Other - Last Name:HALLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1085 I ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5588
Mailing Address - Country:US
Mailing Address - Phone:707-825-1210
Mailing Address - Fax:
Practice Address - Street 1:1085 I ST STE 202
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5588
Practice Address - Country:US
Practice Address - Phone:707-825-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS215571041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW215570Medicaid
CA000001236Medicaid
CACSW215570Medicaid
ZZZ04016ZMedicare UPIN