Provider Demographics
NPI:1982567012
Name:HENICHEK, CARLI (LSW)
Entity type:Individual
Prefix:
First Name:CARLI
Middle Name:
Last Name:HENICHEK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9791 CONSTITUTION LN
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-1671
Mailing Address - Country:US
Mailing Address - Phone:610-865-8177
Mailing Address - Fax:
Practice Address - Street 1:2005 CITY LINE RD STE 300
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7701
Practice Address - Country:US
Practice Address - Phone:610-865-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-05
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123830104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty