Healthcare Provider Details

I. General information

NPI: 1710800487
Provider Name (Legal Business Name): CHAIM HENDERSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S JUNIPER ST FL 3
PHILADELPHIA PA
19107-1316
US

IV. Provider business mailing address

100 S JUNIPER ST FL 3
PHILADELPHIA PA
19107-1316
US

V. Phone/Fax

Practice location:
  • Phone: 201-208-2616
  • Fax:
Mailing address:
  • Phone: 201-208-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020742
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: