Healthcare Provider Details

I. General information

NPI: 1730464298
Provider Name (Legal Business Name): NADINE ANN-MARIE HENRY PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NADINE ANN-MARIE HENRY PSY.D

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S KIRKMAN RD STE 310
ORLANDO FL
32819-7937
US

IV. Provider business mailing address

449 W SILVER STAR RD UNIT 669
OCOEE FL
34761-8027
US

V. Phone/Fax

Practice location:
  • Phone: 407-337-3160
  • Fax: 844-927-4534
Mailing address:
  • Phone: 407-446-2223
  • Fax: 844-927-4534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberSS1075
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1075
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: