Provider Demographics
NPI:1316116775
Name:HENDERSON, KATHERINE O'NEAL (LAC)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:O'NEAL
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 GREENE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4544
Mailing Address - Country:US
Mailing Address - Phone:917-282-7208
Mailing Address - Fax:
Practice Address - Street 1:19 W 21ST ST RM 904
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6851
Practice Address - Country:US
Practice Address - Phone:917-282-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2011-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003500-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist