Provider Demographics
NPI:1659648723
Name:HENRY JR., JAMES MILTON
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MILTON
Last Name:HENRY JR.
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 1:36 CEDAR ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1429
Mailing Address - Country:US
Mailing Address - Phone:617-445-8485
Mailing Address - Fax:
Practice Address - Street 1:42 DIAUTO DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4510
Practice Address - Country:US
Practice Address - Phone:781-885-7252
Practice Address - Fax:781-885-7256
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health