Healthcare Provider Details

I. General information

NPI: 1811540891
Provider Name (Legal Business Name): HEATHER HENRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. HEATHER JENEVE HENRY-IGNACIO

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAF LAKENHEATH BRANDON RD
LAKENHEATH SUFFOLK
IP27 9PS
GB

IV. Provider business mailing address

RAF LAKENHEATH CHESTER STREET
BRANDON LAKENHEATH
IP27 9PS
GB

V. Phone/Fax

Practice location:
  • Phone: 240-810-9441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0617336
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: