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General NPI Number Information
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NPI Number | 1053507699
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Entity Type | Individual
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Provider Name | DESIREE HENRY LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 1164 W KUIAHA RD
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City | HAIKU
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State | HI
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Zip | 96708-5500
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Country | US
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Telephone | 860-964-8692
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 791435
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City | PAIA
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State | HI
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Zip | 96779-1435
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Country | US
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Telephone | 860-964-8692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-3784
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License Number State | HI
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