Provider Demographics
NPI:1053547521
Name:HENDERSON, ROY VICTOR (LSW)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:VICTOR
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 E WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1223
Mailing Address - Country:US
Mailing Address - Phone:330-786-2559
Mailing Address - Fax:330-786-2507
Practice Address - Street 1:570 E WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1223
Practice Address - Country:US
Practice Address - Phone:330-786-2559
Practice Address - Fax:330-786-2507
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-15007104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker