Provider Demographics
NPI:1033989918
Name:HENDERSON, DAUNTE MARTEZ (LCSW)
Entity Type:Individual
Prefix:
First Name:DAUNTE
Middle Name:MARTEZ
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 S DREXEL BLVD APT 605
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-4245
Mailing Address - Country:US
Mailing Address - Phone:347-435-6301
Mailing Address - Fax:
Practice Address - Street 1:4537 S DREXEL BLVD APT 605
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-4245
Practice Address - Country:US
Practice Address - Phone:347-435-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0259621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical