Healthcare Provider Details

I. General information

NPI: 1164778874
Provider Name (Legal Business Name): YASNIEL ENRIQUEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22790 SW 112TH AVE
MIAMI FL
33170-7602
US

IV. Provider business mailing address

14241 SW 296TH ST
HOMESTEAD FL
33033-3009
US

V. Phone/Fax

Practice location:
  • Phone: 305-235-2616
  • Fax:
Mailing address:
  • Phone: 786-255-7333
  • Fax: 305-248-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCBHCMS.0100116
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: