| Doctor Name: | DR. LISA MELLISA GREENE HENDERSON |
| NPI Number: | 1497945034 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | PSY1000375 |
| Business Practice Address: | 5100 Auth Way Kaiser Permanente Marlow Heights Medical Center Suitland, MD - 207464207 |
| Business Phone Number: | 3017025000 |
| Business Fax Number: | |
| Mailing Address: | 2101 E Jefferson St, Kaiser Permanente Medicare Enrollment ROCKVILLE |
| State: | MD |
| Postal Code: | 208524908 |
| Phone Number: | 3018162424 |
| Fax Number: | |
| NPI Enumeration Date: | 07/30/2007 |
| NPI Last Update Date: | 12/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY1000375 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | DC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |