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NPI Code Detail

MEDICARE: MR. JOSEPH GREGORY HENDERSON LCSW

MEDICARE:  MR. JOSEPH GREGORY HENDERSON  LCSW
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
11041C0700XClinical Social Worker34008462AIN

General Provider Information

NPI Number : 1902477102
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSEPH GREGORY HENDERSON LCSW
Provider Business Mailing Address
First Line : 3717 BOUNDARY BAY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46217-9114
Country : US
Telephone Number : 317-919-7147
Fax Number :
Provider Business Practice Location Address
First Line : 3717 BOUNDARY BAY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46217-9114
Country : US
Telephone Number : 317-919-7147
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2021
Last Update Date : 07/08/2021

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Directions to “ MR. JOSEPH GREGORY HENDERSON LCSW” Practice Location

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