| Marla Davis Henry Lcsw | |
|
647 Wicklow Rd Deerfield IL 60015-4522 | |
| (847) 471-3273 | |
| (847) 948-8742 |
| Full Name | Marla Davis Henry Lcsw |
|---|---|
| Speciality | Social Worker |
| Location | 647 Wicklow Rd, Deerfield, Illinois |
| Authorized Official Name and Position | Marla Ilene Davis Henry (PRESIDENT) |
| Authorized Official Contact | 8474713273 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marla Davis Henry Lcsw 647 Wicklow Rd Deerfield IL 60015-4522 Ph: (847) 471-3273 | Marla Davis Henry Lcsw 647 Wicklow Rd Deerfield IL 60015-4522 Ph: (847) 471-3273 |
| NPI Number | 1104288380 |
|---|---|
| Provider Enumeration Date | 03/25/2016 |
| Last Update Date | 01/20/2023 |
| Certification Date | 01/20/2023 |
| Medicare PECOS PAC ID | 9830498252 |
|---|---|
| Medicare Enrollment ID | O20160505001593 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104288380 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149007033 (Illinois) | Primary |
| Provider Name | Marla I Davis Henry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447627088 PECOS PAC ID: 9335448638 Enrollment ID: I20160506001705 |
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