Provider Demographics
NPI:1477893774
Name:HENDERSON, ROBERTO (CADCII,MSW (A))
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:CADCII,MSW (A)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4019 WESTERLY PL STE 102
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2333
Mailing Address - Country:US
Mailing Address - Phone:714-540-9070
Mailing Address - Fax:
Practice Address - Street 1:4019 WESTERLY PL STE 102
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2333
Practice Address - Country:US
Practice Address - Phone:714-540-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA07490315101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)