Provider Demographics
NPI:1356325625
Name:HENRICKS, STEVEN C (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:HENRICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FRONT STREET
Mailing Address - Street 2:SUITE #307
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833
Mailing Address - Country:US
Mailing Address - Phone:603-658-1777
Mailing Address - Fax:603-658-1333
Practice Address - Street 1:24 FRONT STREET
Practice Address - Street 2:#307
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833
Practice Address - Country:US
Practice Address - Phone:603-658-1777
Practice Address - Fax:603-658-1333
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH98652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME231980000Medicaid
F64218Medicare UPIN
HERE4303Medicare ID - Type Unspecified