Provider Demographics
NPI:1215947999
Name:HENRY, VINCENT DEPAUL (PSYD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:DEPAUL
Last Name:HENRY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 EUGENIA DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2309
Mailing Address - Country:US
Mailing Address - Phone:609-714-1340
Mailing Address - Fax:
Practice Address - Street 1:410 EUGENIA DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2309
Practice Address - Country:US
Practice Address - Phone:609-714-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004304L103TC0700X
NJ35SI00189100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3592804Medicaid