Provider Demographics
NPI:1053732404
Name:HENEIN, NANCY (PSYD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:HENEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E 91ST ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1561
Mailing Address - Country:US
Mailing Address - Phone:317-573-0149
Mailing Address - Fax:317-573-0154
Practice Address - Street 1:70 E 91ST ST
Practice Address - Street 2:SUITE 210
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1561
Practice Address - Country:US
Practice Address - Phone:317-573-0149
Practice Address - Fax:317-573-0154
Is Sole Proprietor?:No
Enumeration Date:2014-01-01
Last Update Date:2014-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042133A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical