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General NPI Number Information
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NPI Number | 1245917129
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Entity Type | Individual
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Provider Name | MICA HENDERSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 159 W 53RD ST APT 33H
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City | NEW YORK
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State | NY
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Zip | 10019-6068
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Country | US
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Telephone | 516-986-8438
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Fax |
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Provider Business Mailing Address
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Address Line | 10 JUMEL TER
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City | NEW YORK
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State | NY
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Zip | 10032-5332
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Country | US
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Telephone | 917-482-7130
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 100187
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License Number State | NY
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