Provider Demographics
NPI:1427433481
Name:HENDERSON, DANIELLE (PSYD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1736
Mailing Address - Country:US
Mailing Address - Phone:609-969-2497
Mailing Address - Fax:
Practice Address - Street 1:107 CHESLEY DR STE 2
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1760
Practice Address - Country:US
Practice Address - Phone:610-529-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional