Provider Demographics
NPI:1316012917
Name:HENRY, CARA (LICSW)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
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 1:814 THAYER ST
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-5017
Mailing Address - Country:US
Mailing Address - Phone:781-820-4530
Mailing Address - Fax:
Practice Address - Street 1:1035 BEDFORD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-3015
Practice Address - Country:US
Practice Address - Phone:781-820-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1103301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHE-P23880Medicare ID - Type Unspecified