Individual
ELLIE RENEE HENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
702 RUSSELL BLVD, FORT WALTON BEACH, FL 32547-3131
(850) 261-5374
Mailing address
702 RUSSELL BLVD, FORT WALTON BEACH, FL 32547-3131
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW25277
FL
Other
Enumeration date
08/29/2025
Last updated
08/29/2025
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