| Dennis M Henderson Psychological Services Pc | |
|
12 Gildare Dr East Northport NY 11731-3223 | |
| (631) 368-8502 | |
| (631) 368-8502 |
| Full Name | Dennis M Henderson Psychological Services Pc |
|---|---|
| Speciality | Psychologist |
| Location | 12 Gildare Dr, East Northport, New York |
| Authorized Official Name and Position | Dennis Malcolm Henderson (PRESIDENT/CEO) |
| Authorized Official Contact | 6313688502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dennis M Henderson Psychological Services Pc 12 Gildare Dr East Northport NY 11731-3223 Ph: (631) 368-8502 | Dennis M Henderson Psychological Services Pc 12 Gildare Dr East Northport NY 11731-3223 Ph: (631) 368-8502 |
| NPI Number | 1518158088 |
|---|---|
| Provider Enumeration Date | 08/08/2007 |
| Last Update Date | 08/08/2007 |
| Medicare PECOS PAC ID | 9638068075 |
|---|---|
| Medicare Enrollment ID | O20040312001043 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518158088 | NPI | - | NPPES |
| 01660731 | Medicaid | NY | |
| 1639287758 | Other | NY | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 0117921 (New York) | Primary |
| Provider Name | Dennis M Henderson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639287758 PECOS PAC ID: 0648262014 Enrollment ID: I20040402001202 |
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