Healthcare Provider Details

I. General information

NPI: 1609501840
Provider Name (Legal Business Name): QUANSHAY HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 PARK AVE
BALTIMORE MD
21201-5633
US

IV. Provider business mailing address

1826 PENNSYLVANIA AVE UNIT 3782
BALTIMORE MD
21217-7504
US

V. Phone/Fax

Practice location:
  • Phone: 443-738-0300
  • Fax:
Mailing address:
  • Phone: 443-839-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number28747
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28747
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: