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General NPI Number Information
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NPI Number | 1770868549
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Entity Type | Individual
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Provider Name | MARIA J ENRIQUEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 2509 PICO BLVD 3RD FLOOR
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City | SANTA MONICA
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State | CA
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Zip | 90405-1828
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Country | US
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Telephone | 310-665-7521
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Fax | 310-664-7589
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Provider Business Mailing Address
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Address Line | 604 ROSE AVE
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City | VENICE
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State | CA
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Zip | 90291-2767
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Country | US
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Telephone | 310-664-7521
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Fax | 310-664-7589
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 27637
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License Number State | CA
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