Provider Demographics
NPI:1073248340
Name:BORIS ENOWITCH MS LCSW LLC
Entity type:Organization
Organization Name:BORIS ENOWITCH MS LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ENOWITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCSW
Authorized Official - Phone:860-805-6386
Mailing Address - Street 1:12 CROSSROADS PLZ UNIT 370093
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06137-7705
Mailing Address - Country:US
Mailing Address - Phone:860-805-6386
Mailing Address - Fax:
Practice Address - Street 1:81 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2405
Practice Address - Country:US
Practice Address - Phone:860-805-6386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty