1407339633 NPI number — REGINALD ANTHONY MCHENRY II LMSW

Table of content: REGINALD ANTHONY MCHENRY II LMSW (NPI 1407339633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407339633 NPI number — REGINALD ANTHONY MCHENRY II LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCHENRY
Provider First Name:
REGINALD
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
LMSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407339633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7474 GREENWAY CENTER DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-3524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-304-3327
Provider Business Mailing Address Fax Number:
410-609-7091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6410 DOBBIN RD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-4774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-304-3327
Provider Business Practice Location Address Fax Number:
410-609-7091
Provider Enumeration Date:
09/13/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  27132 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)