Doctor Name: | MRS. SHONDRA HENRY |
NPI Number: | 1275925455 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | C009352 |
Business Practice Address: | 11050 Mount Belvedere Blvd Fort Drum, NY - 136025438 |
Business Phone Number: | 3157720959 |
Business Fax Number: | |
Mailing Address: | 94110a Sycamore Dr, FORT DRUM |
State: | NY |
Postal Code: | 136033512 |
Phone Number: | 2104886994 |
Fax Number: | |
NPI Enumeration Date: | 02/25/2015 |
NPI Last Update Date: | 02/25/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | C009352 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |