Healthcare Provider Details

I. General information

NPI: 1104477793
Provider Name (Legal Business Name): RENEE CHRISTIANNE HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ARARAT ST
WORCESTER MA
01606-3328
US

IV. Provider business mailing address

11 EUCLID AVE APT 1
WORCESTER MA
01610-3548
US

V. Phone/Fax

Practice location:
  • Phone: 508-341-2829
  • Fax:
Mailing address:
  • Phone: 508-942-0544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: