MEDICARE: CHRISTINE ENRIQUEZ M.S., BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst
2	103K00000X	Behavior Analyst	1-17-26493

General Provider Information

NPI Number	:	1205295656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE ENRIQUEZ M.S., BCBA

Provider Business Mailing Address
First Line	:	15 LAROC RD
Second Line	:
City	:	CHESTER
State	:	NY
Zip	:	10918-4512
Country	:	US
Telephone Number	:	845-325-9552
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 E STAN SCHLUETER LOOP
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-5481
Country	:	US
Telephone Number	:	845-325-9552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2016
Last Update Date	:	07/21/2022

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