MEDICARE: LAURA ANNE HENRY

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
1	1041C0700X	Clinical Social Worker	R031336-1	NY

General Provider Information

NPI Number	:	1427363308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ANNE HENRY

Provider Business Mailing Address
First Line	:	5 HOUSTON AVE
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-2306
Country	:	US
Telephone Number	:	845-782-3686
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 HOUSTON AVE
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-2306
Country	:	US
Telephone Number	:	845-782-3686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	08/16/2010

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