1811540891 NPI number — HEATHER HENRY LCSW

Table of content: HEATHER HENRY LCSW (NPI 1811540891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811540891 NPI number — HEATHER HENRY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRY
Provider First Name:
HEATHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENRY-IGNACIO
Provider Other First Name:
HEATHER
Provider Other Middle Name:
JENEVE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811540891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RAF LAKENHEATH
Provider Second Line Business Mailing Address:
CHESTER STREET
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
LAKENHEATH
Provider Business Mailing Address Postal Code:
IP27 9PS
Provider Business Mailing Address Country Code:
GB
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RAF LAKENHEATH
Provider Second Line Business Practice Location Address:
BRANDON RD
Provider Business Practice Location Address City Name:
LAKENHEATH
Provider Business Practice Location Address State Name:
SUFFOLK
Provider Business Practice Location Address Postal Code:
IP27 9PS
Provider Business Practice Location Address Country Code:
GB
Provider Business Practice Location Address Telephone Number:
240-810-9441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2019

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: 1041C0700X , with the licence number:  0617336 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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