Healthcare Provider Details

I. General information

NPI: 1447082029
Provider Name (Legal Business Name): CIALEE ENSLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 SCHENECTADY AVE
BROOKLYN NY
11213-2330
US

IV. Provider business mailing address

1649 SUMMERFIELD ST APT 2A
RIDGEWOOD NY
11385-5719
US

V. Phone/Fax

Practice location:
  • Phone: 347-915-1112
  • Fax:
Mailing address:
  • Phone: 714-262-8886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: