Provider Demographics
NPI:1578201786
Name:HENRIQUEZ, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ROUTE 101 STE 11
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5031
Mailing Address - Country:US
Mailing Address - Phone:603-471-2522
Mailing Address - Fax:877-754-5246
Practice Address - Street 1:13 BRANCH ST STE 203
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1900
Practice Address - Country:US
Practice Address - Phone:978-655-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician