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General NPI Number Information
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NPI Number | 1598839409
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Entity Type | Individual
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Provider Name | ENDRA KIESHA HENRY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 400 COMMUNITY DR
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City | MANHASSET
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State | NY
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Zip | 11030-3815
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Country | US
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Telephone | 516-562-3271
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Fax | 516-562-4786
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Provider Business Mailing Address
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Address Line | 11 NUVERN AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10550-4818
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Country | US
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Telephone | 914-393-5592
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Fax | 914-699-6493
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 018013
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License Number State | NY
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