Doctor Name: | MARLENE HENDERSON |
NPI Number: | 1275939209 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1454826 |
Business Practice Address: | 522 Glenwood Ave New Boston, OH - 456625505 |
Business Phone Number: | 7403540270 |
Business Fax Number: | |
Mailing Address: | 522 Glenwood Ave, NEW BOSTON |
State: | OH |
Postal Code: | 456625505 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/19/2014 |
NPI Last Update Date: | 11/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 1454826 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |