Provider Demographics
NPI:1194186205
Name:HENRY, PAULA M (LICSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:HENRY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORDWAINER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1671
Mailing Address - Country:US
Mailing Address - Phone:781-878-8340
Mailing Address - Fax:339-788-9904
Practice Address - Street 1:200 CORDWAINER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1671
Practice Address - Country:US
Practice Address - Phone:781-878-8340
Practice Address - Fax:339-788-9904
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1177151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical