MEDICARE: DR. IRIS WARREN HENRY PH.D.

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	103TC0700X	Clinical Psychologist	018703	NY

General Provider Information

NPI Number	:	1710296546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRIS WARREN HENRY PH.D.

Provider Business Mailing Address
First Line	:	96 FIFTH AVENUE
Second Line	:	SUITE 1K
City	:	NEW YORK
State	:	NY
Zip	:	10009-2801
Country	:	US
Telephone Number	:	917-623-3119
Fax Number	:

Provider Business Practice Location Address
First Line	:	96 FIFTH AVENUE
Second Line	:	SUITE 1K
City	:	NEW YORK
State	:	NY
Zip	:	10009-2801
Country	:	US
Telephone Number	:	917-623-3119
Fax Number	:

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

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	04/12/2012

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