Healthcare Provider Details

I. General information

NPI: 1891577367
Provider Name (Legal Business Name): ROBERT DEE HENSON I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26170 BENTON AVE # 0
EUCLID OH
44132-2514
US

IV. Provider business mailing address

26170 BENTON AVE # 0
EUCLID OH
44132-2514
US

V. Phone/Fax

Practice location:
  • Phone: 216-924-9342
  • Fax:
Mailing address:
  • Phone: 216-924-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: