Provider Demographics
NPI:1124165832
Name:HENNINGS, MIRIAM (LCSW)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:HENNINGS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MEADOWLARK RD
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1209
Mailing Address - Country:US
Mailing Address - Phone:914-995-5233
Mailing Address - Fax:
Practice Address - Street 1:53 S BROADWAY FL 5
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4038
Practice Address - Country:US
Practice Address - Phone:914-231-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0725001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical