Healthcare Provider Details

I. General information

NPI: 1407149735
Provider Name (Legal Business Name): HENLOPEN PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32711 LONG NECK RD
MILLSBORO DE
19966-6678
US

IV. Provider business mailing address

15 DOGWOOD DR
HARBESON DE
19951-9484
US

V. Phone/Fax

Practice location:
  • Phone: 302-561-0290
  • Fax:
Mailing address:
  • Phone: 302-561-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberB1-0000877
License Number StateDE

VIII. Authorized Official

Name: DR. MARGARET ANN GOODWIN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 302-561-0290