Provider Demographics
NPI:1083436927
Name:HENRY, SHARLENE EARLENE
Entity type:Individual
Prefix:
First Name:SHARLENE
Middle Name:EARLENE
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 BROADWAY APT 3
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-6317
Mailing Address - Country:US
Mailing Address - Phone:646-648-6402
Mailing Address - Fax:718-448-1903
Practice Address - Street 1:220 HEBERTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1415
Practice Address - Country:US
Practice Address - Phone:718-448-1900
Practice Address - Fax:718-448-1903
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)