Provider Demographics
NPI:1619052818
Name:HENNINGSEN, NANCY H (LCSWC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:H
Last Name:HENNINGSEN
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 ORKNEY PKWY
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-4918
Mailing Address - Country:US
Mailing Address - Phone:301-320-3176
Mailing Address - Fax:
Practice Address - Street 1:8607 2ND AVE
Practice Address - Street 2:407A
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3355
Practice Address - Country:US
Practice Address - Phone:301-661-4433
Practice Address - Fax:301-582-6461
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12280103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003140200Medicaid
492048Medicare ID - Type Unspecified