Healthcare Provider Details

I. General information

NPI: 1700333630
Provider Name (Legal Business Name): JOSHUA FRANCIS ENOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 WILLARD ST
QUINCY MA
02169-7482
US

IV. Provider business mailing address

859 WILLARD ST STE 430
QUINCY MA
02169-7490
US

V. Phone/Fax

Practice location:
  • Phone: 617-847-1909
  • Fax:
Mailing address:
  • Phone: 617-430-4810
  • Fax: 857-214-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: