Provider Demographics
NPI:1679798052
Name:HENRY, MARIJAYNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIJAYNE
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 NOTTINGHILL LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-4009
Mailing Address - Country:US
Mailing Address - Phone:856-265-4630
Mailing Address - Fax:
Practice Address - Street 1:741 MOUNT LUCAS RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1911
Practice Address - Country:US
Practice Address - Phone:609-688-3789
Practice Address - Fax:609-497-3324
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05232000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health