MEDICARE: SUHADEE HENRIQUEZ

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	1041S0200X	School Social Worker	390200000X	CA

General Provider Information

NPI Number	:	1912153933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUHADEE HENRIQUEZ

Provider Business Mailing Address
First Line	:	475 48TH AVE
Second Line	:	3006
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5501
Country	:	US
Telephone Number	:	646-302-2126
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 48TH AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5501
Country	:	US
Telephone Number	:	646-302-2126
Fax Number	:

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

Provider Enumeration Date	:	08/10/2008
Last Update Date	:	10/22/2013

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