Provider Demographics
NPI:1639596893
Name:HENDERSON, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
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 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3750
Mailing Address - Country:US
Mailing Address - Phone:978-263-3427
Mailing Address - Fax:978-263-3498
Practice Address - Street 1:360 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3750
Practice Address - Country:US
Practice Address - Phone:978-263-3427
Practice Address - Fax:978-263-3498
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health