Provider Demographics
NPI:1053000638
Name:HENDERSON, BETH ANNE (LMSW)
Entity type:Individual
Prefix:
First Name:BETH ANNE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 62ND ST APT A15
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-9113
Mailing Address - Country:US
Mailing Address - Phone:302-547-8183
Mailing Address - Fax:
Practice Address - Street 1:6901 62ND ST APT A15
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-9113
Practice Address - Country:US
Practice Address - Phone:302-547-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1176091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical