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General NPI Number Information
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NPI Number | 1518158088
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Entity Type | Organization
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Legal Business Name | DENNIS M HENDERSON PSYCHOLOGICAL SERVICES PC
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 12 GILDARE DR
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-3223
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Country | US
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Telephone | 631-368-8502
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Fax | 631-368-8502
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Provider Business Mailing Address
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Address Line | 12 GILDARE DR
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-3223
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Country | US
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Telephone | 631-368-8502
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Fax | 631-368-8502
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. DENNIS MALCOLM HENDERSON
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Credential | PHD
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Telephone | 631-368-8502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0117921
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License Number State | NY
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