Provider Demographics
NPI:1093713653
Name:HENRY, FREDERICK E (MSW)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:E
Last Name:HENRY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 LINGLESTOWN RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-9183
Mailing Address - Country:US
Mailing Address - Phone:717-545-1427
Mailing Address - Fax:717-545-1428
Practice Address - Street 1:4800 LINGLESTOWN RD
Practice Address - Street 2:SUITE 303
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-9183
Practice Address - Country:US
Practice Address - Phone:717-545-1427
Practice Address - Fax:717-545-1428
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0142261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001528925Medicaid
S56579Medicare UPIN
PA455135Medicare ID - Type Unspecified