Provider Demographics
NPI:1578115309
Name:HENRY, AYISHA MONIQUE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:AYISHA
Middle Name:MONIQUE
Last Name:HENRY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 OCEAN AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4411
Mailing Address - Country:US
Mailing Address - Phone:347-520-3356
Mailing Address - Fax:
Practice Address - Street 1:500 BI COUNTY BLVD STE 450
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3995
Practice Address - Country:US
Practice Address - Phone:516-265-4177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician