Provider Demographics
NPI:1093931776
Name:HENRIQUES, RONA INGRID (LCSW)
Entity Type:Individual
Prefix:
First Name:RONA
Middle Name:INGRID
Last Name:HENRIQUES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 WOODVALE ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5106
Mailing Address - Country:US
Mailing Address - Phone:352-432-2127
Mailing Address - Fax:352-432-2127
Practice Address - Street 1:450 E HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2581
Practice Address - Country:US
Practice Address - Phone:352-432-2127
Practice Address - Fax:352-432-2127
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22987311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical