Provider Demographics
NPI:1003981374
Name:HENDERY, MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HENDERY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WASHINGTON ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3890
Mailing Address - Country:US
Mailing Address - Phone:603-953-5254
Mailing Address - Fax:603-430-3753
Practice Address - Street 1:2 WASHINGTON ST
Practice Address - Street 2:SUITE 314
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3890
Practice Address - Country:US
Practice Address - Phone:603-953-5254
Practice Address - Fax:603-430-3753
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NH1179103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706655Y0NH01OtherBHN
NH99003227Medicaid
NH7706655Y0NH01OtherBHN