Provider Demographics
NPI:1679316806
Name:ENRIQUEZ, CASSANDRA LUCIA (LP)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LUCIA
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-1828
Mailing Address - Country:US
Mailing Address - Phone:703-300-3220
Mailing Address - Fax:
Practice Address - Street 1:159 BLEECKER ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1457
Practice Address - Country:US
Practice Address - Phone:917-382-8075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health