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General NPI Number Information
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NPI Number | 1578709077
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Entity Type | Individual
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Provider Name | JUSTIN DANIEL HENDERSON L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 325 SENTRY PKWY E STE 301 PMB 1011
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City | BLUE BELL
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State | PA
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Zip | 19422
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Country | US
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Telephone | 610-910-4881
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Fax |
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Provider Business Mailing Address
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Address Line | 325 SENTRY PKWY E STE 301 PMB 1011
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City | BLUE BELL
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State | PA
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Zip | 19422
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Country | US
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Telephone | 610-910-4881
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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 | CW017781
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | Q1-0012807
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License Number State | DE
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