Provider Demographics
NPI:1548220262
Name:HENRY, GEORGE FAY JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:FAY
Last Name:HENRY
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 MEADOW LN
Mailing Address - Street 2:UNIT 1B
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-5203
Mailing Address - Country:US
Mailing Address - Phone:312-504-5560
Mailing Address - Fax:
Practice Address - Street 1:12311 MEADOW LN
Practice Address - Street 2:UNIT 1B
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-5203
Practice Address - Country:US
Practice Address - Phone:312-504-5560
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14901011931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical