Healthcare Provider Details

I. General information

NPI: 1073763702
Provider Name (Legal Business Name): DANIELLE ENSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 BLUE OAKS BLVD STE 120
ROSEVILLE CA
95747-5156
US

IV. Provider business mailing address

1430 BLUE OAKS BLVD STE 120
ROSEVILLE CA
95747-5156
US

V. Phone/Fax

Practice location:
  • Phone: 916-540-6846
  • Fax:
Mailing address:
  • Phone: 916-540-6848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number59965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: