Healthcare Provider Details

I. General information

NPI: 1508799602
Provider Name (Legal Business Name): CLIODHNA HENDERSON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NEW JERSEY AVE SE STE 500
WASHINGTON DC
20003-3326
US

IV. Provider business mailing address

404 JEFFERSON ST NE
WASHINGTON DC
20011-2639
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200002231
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: