Provider Demographics
NPI:1578709077
Name:HENDERSON, JUSTIN DANIEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:DANIEL
Last Name:HENDERSON
Suffix:
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 1:614 N EASTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4301
Mailing Address - Country:US
Mailing Address - Phone:215-884-9770
Mailing Address - Fax:
Practice Address - Street 1:614 N EASTON RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4301
Practice Address - Country:US
Practice Address - Phone:215-884-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW017781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health