MEDICARE: MR. JOSEPH GREGORY HENDERSON 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
1	1041C0700X	Clinical Social Worker	34008462A	IN

General Provider Information

NPI Number	:	1902477102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH GREGORY HENDERSON LCSW

Provider Business Mailing Address
First Line	:	3717 BOUNDARY BAY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-9114
Country	:	US
Telephone Number	:	317-919-7147
Fax Number	:

Provider Business Practice Location Address
First Line	:	3717 BOUNDARY BAY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-9114
Country	:	US
Telephone Number	:	317-919-7147
Fax Number	:

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

Provider Enumeration Date	:	07/08/2021
Last Update Date	:	07/08/2021

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