Healthcare Provider Details

I. General information

NPI: 1609956002
Provider Name (Legal Business Name): DENISE LLYN HENDERSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 ALEXANDER ST SUITE305
ROCHESTER NY
14607-1920
US

IV. Provider business mailing address

277 ALEXANDER ST SUITE305
ROCHESTER NY
14607-1920
US

V. Phone/Fax

Practice location:
  • Phone: 585-325-1970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number009875-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: