Provider Demographics
NPI:1174279954
Name:MCHENRY, MADISON LYNN
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LYNN
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 NARROWS RD
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1636
Mailing Address - Country:US
Mailing Address - Phone:508-828-8136
Mailing Address - Fax:
Practice Address - Street 1:90 HAWES WAY
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1163
Practice Address - Country:US
Practice Address - Phone:781-573-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician