Provider Demographics
NPI:1346385382
Name:HENDERSON, BARBARA SUE DOMINGO (MA)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA SUE
Middle Name:DOMINGO
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:SUE
Other - Last Name:DOMINGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:308 WILKINSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-1828
Mailing Address - Country:US
Mailing Address - Phone:502-330-9696
Mailing Address - Fax:
Practice Address - Street 1:308 WILKINSON ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-1828
Practice Address - Country:US
Practice Address - Phone:502-330-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY110103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical