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NPI Code Detail

MEDICARE: VIVIAN K HENDERSON LCSW-C

MEDICARE: VIVIAN K HENDERSON LCSW-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker19463MD

General Provider Information

NPI Number : 1083033815
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIVIAN K HENDERSON LCSW-C
Provider Business Mailing Address
First Line : 10451 MILL RUN CIR STE 400
Second Line :
City : OWINGS MILLS
State : MD
Zip : 21117-5594
Country : US
Telephone Number : 443-219-8482
Fax Number :
Provider Business Practice Location Address
First Line : 10451 MILL RUN CIR STE 400
Second Line :
City : OWINGS MILLS
State : MD
Zip : 21117-5594
Country : US
Telephone Number : 443-219-8482
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2014
Last Update Date : 02/04/2021

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Directions to “ VIVIAN K HENDERSON LCSW-C” Practice Location

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