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NPI Code Detail

MEDICARE: MS. GWENDOLYN ORCHID HENRY LMSW

MEDICARE: MS. GWENDOLYN ORCHID HENRY LMSW
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 Worker6801067541MI

General Provider Information

NPI Number : 1578577706
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GWENDOLYN ORCHID HENRY LMSW
Provider Business Mailing Address
First Line : 916 W OWENS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2516
Country : US
Telephone Number : 702-636-4060
Fax Number : 702-633-4079
Provider Business Practice Location Address
First Line : 916 W OWENS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2516
Country : US
Telephone Number : 702-636-4060
Fax Number : 702-636-4079
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 04/20/2009

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