Healthcare Provider Details

I. General information

NPI: 1003170580
Provider Name (Legal Business Name): SUSAN ELISABET ENCK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 JEFFERSON BLVD
WARWICK RI
02888-1027
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-941-2830
  • Fax: 401-941-6886
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS02005
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: