Healthcare Provider Details

I. General information

NPI: 1245635309
Provider Name (Legal Business Name): DONNA ENFIELD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EXIT 102 1/2 MI S OF I-40
SAN FIDEL NM
87049
US

IV. Provider business mailing address

PO BOX 130
SAN FIDEL NM
87049-0130
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5317
  • Fax:
Mailing address:
  • Phone: 505-552-5317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberX-08924
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: