Provider Demographics
NPI:1992278485
Name:HENRY, SHERENE STACEY-ANN (MS, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:SHERENE
Middle Name:STACEY-ANN
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:522 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4467
Practice Address - Country:US
Practice Address - Phone:917-975-8992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2023-01-13
Deactivation Date:2020-12-23
Deactivation Code:
Reactivation Date:2021-01-11
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NY012789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker