Healthcare Provider Details

I. General information

NPI: 1346772589
Provider Name (Legal Business Name): DR. ROBERT R HENDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 NW 39TH AVE
GAINESVILLE FL
32606-5635
US

IV. Provider business mailing address

PO BOX 100256
GAINESVILLE FL
32610-0256
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-4357
  • Fax:
Mailing address:
  • Phone: 352-294-4900
  • Fax: 352-294-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004688
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY11285
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: