MEDICARE: CHRISTINE DURBIN HENDERSON

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	1041C0700X	Clinical Social Worker	I.1700550	OH

General Provider Information

NPI Number	:	1730607177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE DURBIN HENDERSON

Provider Business Mailing Address
First Line	:	25701 N LAKELAND BLVD STE 403
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-2453
Country	:	US
Telephone Number	:	440-865-0364
Fax Number	:

Provider Business Practice Location Address
First Line	:	1941 SAGAMORE DR
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44117-2314
Country	:	US
Telephone Number	:	216-486-2999
Fax Number	:	216-486-3951

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

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	09/23/2020

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