Healthcare Provider Details

I. General information

NPI: 1760116529
Provider Name (Legal Business Name): JENNIFER HENRY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 BRODHEAD RD
BETHLEHEM PA
18017-8938
US

IV. Provider business mailing address

257 BRODHEAD RD
BETHLEHEM PA
18017-8938
US

V. Phone/Fax

Practice location:
  • Phone: 484-822-5700
  • Fax:
Mailing address:
  • Phone: 484-526-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS019205
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: