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General NPI Number Information
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NPI Number | 1326768102
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Entity Type | Individual
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Provider Name | DOROTEA SHANELLE ENRIQUEZ LSW
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Gender | Female
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1060 KINGS HWY N STE 314
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City | CHERRY HILL
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State | NJ
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Zip | 08034-1910
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Country | US
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Telephone | 856-285-5861
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Fax |
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Provider Business Mailing Address
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Address Line | 129 E ATLANTIC AVE
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City | AUDUBON
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State | NJ
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Zip | 08106-1431
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Country | US
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Telephone | 856-981-1515
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL07233800
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License Number State | NJ
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