Provider Demographics
NPI:1588722862
Name:HENEL, PATRICIA A (PH D)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:HENEL
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 EAST SANFORD STREET
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-792-0208
Mailing Address - Fax:518-792-3983
Practice Address - Street 1:260 EAST SANFORD STREET
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-792-0208
Practice Address - Fax:518-792-3983
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0063121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS063123BOtherWORKERS COMPENSATION BOAR
NY00698233Medicaid
NYS063123BOtherWORKERS COMPENSATION BOAR
D00961Medicare UPIN