Provider Demographics
NPI:1467592329
Name:HENDERSON, KATHRYN ELIZABETH (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W NORWALK RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-4410
Mailing Address - Country:US
Mailing Address - Phone:203-858-2472
Mailing Address - Fax:203-831-8070
Practice Address - Street 1:71 EAST AVE
Practice Address - Street 2:SUITE T
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4903
Practice Address - Country:US
Practice Address - Phone:203-858-2472
Practice Address - Fax:203-831-8070
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional