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NPI Code Detail

MEDICARE: MRS. MARTRICE DENISE HENDERSON-ALDRIDGE LCSW

MEDICARE: MRS. MARTRICE DENISE HENDERSON-ALDRIDGE LCSW
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 Worker149007872IL
21041C0700XClinical Social Worker110607TX

General Provider Information

NPI Number : 1871668418
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARTRICE DENISE HENDERSON-ALDRIDGE LCSW
Provider Business Mailing Address
First Line : 2990 N PERRYVILLE RD UNIT 4100A
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-6827
Country : US
Telephone Number : 815-975-3330
Fax Number : 779-423-1761
Provider Business Practice Location Address
First Line : 3019 N PERRYVILLE RD
Second Line :
City : ROCKFORD
State : IL
Zip : 61114-8016
Country : US
Telephone Number : 815-975-3330
Fax Number : 779-423-1761
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2006
Last Update Date : 09/26/2024

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