Healthcare Provider Details

I. General information

NPI: 1104144302
Provider Name (Legal Business Name): INA ENRIQUEZ M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: INA GOULD

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 IYANNOUGH RD
HYANNIS MA
02601-1839
US

IV. Provider business mailing address

8 SPARROWHAWK RD
HARWICH MA
02645-2167
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-1839
  • Fax:
Mailing address:
  • Phone: 508-778-1839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: