MEDICARE: BRENT N HENDERSON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS015211	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11440288	OTHER	PA	CAQH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578534756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT N HENDERSON PHD

Provider Business Mailing Address
First Line	:	2 HOT METAL ST
Second Line	:	QUANTUM ONE, N430
City	:	PITTSBURGH
State	:	PA
Zip	:	15203-2348
Country	:	US
Telephone Number	:	412-432-7706
Fax Number	:	412-432-7691

Provider Business Practice Location Address
First Line	:	5115 CENTRE AVE
Second Line	:	SUITE 140
City	:	PITTSBURGH
State	:	PA
Zip	:	15232-1301
Country	:	US
Telephone Number	:	412-623-5888
Fax Number	:	412-623-5980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/28/2009

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Directions to “ BRENT N HENDERSON PHD” Practice Location

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