Provider Demographics
NPI:1477710093
Name:HENRY, JEAN (PHD MSS)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:PHD MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W RITTENHOUSE SQ
Mailing Address - Street 2:STE 11 A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5737
Mailing Address - Country:US
Mailing Address - Phone:215-731-9993
Mailing Address - Fax:
Practice Address - Street 1:1608 WALNUT ST
Practice Address - Street 2:STE 1300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5457
Practice Address - Country:US
Practice Address - Phone:215-731-9993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0072331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical