Healthcare Provider Details

I. General information

NPI: 1023898939
Provider Name (Legal Business Name): DR. LUKE HENDREN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RETREAT AVE
HARTFORD CT
06106-3310
US

IV. Provider business mailing address

200 RETREAT AVE BLDG 1
HARTFORD CT
06106-3310
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-7514
  • Fax:
Mailing address:
  • Phone: 860-545-7514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4622
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: