Provider Demographics
NPI:1427542836
Name:HENEGHAN, MARTHA (PA, MHC-LP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:HENEGHAN
Suffix:
Gender:F
Credentials:PA, MHC-LP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29 PIONEER ST STE 203
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1050
Mailing Address - Country:US
Mailing Address - Phone:607-437-2352
Mailing Address - Fax:
Practice Address - Street 1:29 PIONEER ST STE 203
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1050
Practice Address - Country:US
Practice Address - Phone:607-437-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010562-01101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health