Healthcare Provider Details

I. General information

NPI: 1477893774
Provider Name (Legal Business Name): ROBERTO ARMANDO HENDERSON M.S.,CAADAC,NAMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 OSTROM AVE
LONG BEACH CA
90815-1602
US

IV. Provider business mailing address

2653 OSTROM AVE
LONG BEACH CA
90815-1602
US

V. Phone/Fax

Practice location:
  • Phone: 949-201-3592
  • Fax:
Mailing address:
  • Phone: 949-201-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA07490315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: