Provider Demographics
NPI:1124387816
Name:HENDRON, MARISA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:
Last Name:HENDRON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 E WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3157
Mailing Address - Country:US
Mailing Address - Phone:702-912-5848
Mailing Address - Fax:
Practice Address - Street 1:1820 E. WARM SPRINGS RD
Practice Address - Street 2:SUITE 115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4680
Practice Address - Country:US
Practice Address - Phone:702-263-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0759103TM1800X, 103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist