Provider Demographics
NPI:1285611814
Name:ENOS, CHRISTINE L (LICSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:ENOS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3906
Mailing Address - Country:US
Mailing Address - Phone:401-435-4147
Mailing Address - Fax:
Practice Address - Street 1:610 WAMPANOAG TRL
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-1504
Practice Address - Country:US
Practice Address - Phone:401-431-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW012571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIISW01257OtherSOCIAL WORK LICENSE
RI62-59567OtherUNITED BEHAVIORAL HEALTH
RICA26320Medicaid
30015-7OtherBLUE CROSS
RI407210OtherBLUE CHIP
30015-7OtherBLUE CROSS