Healthcare Provider Details

I. General information

NPI: 1518364579
Provider Name (Legal Business Name): CARLENY HENRIQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAPLE ST
HOLYOKE MA
01040-5144
US

IV. Provider business mailing address

575 BEECH ST
HOLYOKE MA
01040-2223
US

V. Phone/Fax

Practice location:
  • Phone: 413-420-2200
  • Fax:
Mailing address:
  • Phone: 413-534-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN2296631
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number14497
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN2296631
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: