Provider Demographics
NPI:1386705523
Name:HENRY, NEIL (LCSW)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2701
Mailing Address - Country:US
Mailing Address - Phone:516-868-7553
Mailing Address - Fax:516-868-0444
Practice Address - Street 1:775 BROOKLYN AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2948
Practice Address - Country:US
Practice Address - Phone:516-868-0444
Practice Address - Fax:516-868-0444
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY19631Medicare ID - Type UnspecifiedMEDICARE