Provider Demographics
NPI:1104977305
Name:HENRY, NOELLE M
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:M
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:PO BOX 1243
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-7243
Mailing Address - Country:US
Mailing Address - Phone:302-573-1367
Mailing Address - Fax:
Practice Address - Street 1:121 W LOOCKERMAN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7325
Practice Address - Country:US
Practice Address - Phone:302-266-6200
Practice Address - Fax:302-266-6212
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ3-00103931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000041237Medicaid