MEDICARE: DENISE W HENDERSON MD/ABPN

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	103TB0200X	Cognitive & Behavioral Psychologist	A067876	CA

General Provider Information

NPI Number	:	1831107937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE W HENDERSON MD/ABPN

Provider Business Mailing Address
First Line	:	6060 SUNRISE VISTA DR
Second Line	:	SUITE 2200
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7053
Country	:	US
Telephone Number	:	916-721-8100
Fax Number	:	916-721-8117

Provider Business Practice Location Address
First Line	:	6060 SUNRISE VISTA DR
Second Line	:	SUITE 2200
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7053
Country	:	US
Telephone Number	:	916-721-8100
Fax Number	:	916-721-8117

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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