Provider Demographics
NPI:1710296546
Name:HENRY, IRIS WARREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:WARREN
Last Name:HENRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 FIFTH AVENUE
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2801
Mailing Address - Country:US
Mailing Address - Phone:917-623-3119
Mailing Address - Fax:
Practice Address - Street 1:96 FIFTH AVENUE
Practice Address - Street 2:SUITE 1K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2801
Practice Address - Country:US
Practice Address - Phone:917-623-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical