Basic Information
Provider Information
NPI: 1952903478
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ENQUIST
FirstName: HANNAH
MiddleName: KATE
NamePrefix:  
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1156 N BROADWAY
Address2:  
City: YONKERS
State: NY
PostalCode: 107011108
CountryCode: US
TelephoneNumber: 9149653700
FaxNumber:  
Practice Location
Address1: 1156 N BROADWAY
Address2:  
City: YONKERS
State: NY
PostalCode: 107011108
CountryCode: US
TelephoneNumber: 9149653700
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/10/2020
LastUpdateDate: 06/16/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/16/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041S0200X110801NYY Behavioral Health & Social Service ProvidersSocial WorkerSchool

No ID Information.


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