Healthcare Provider Details

I. General information

NPI: 1215947999
Provider Name (Legal Business Name): VINCENT DEPAUL HENRY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 EUGENIA DR
MEDFORD NJ
08055-2309
US

IV. Provider business mailing address

410 EUGENIA DR
MEDFORD NJ
08055-2309
US

V. Phone/Fax

Practice location:
  • Phone: 609-714-1340
  • Fax:
Mailing address:
  • Phone: 609-714-1340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS004304L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00189100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: