Provider Demographics
NPI:1730119082
Name:HENRY, JEN E (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:JEN
Middle Name:E
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5784 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5702
Mailing Address - Country:US
Mailing Address - Phone:716-479-4506
Mailing Address - Fax:716-871-1306
Practice Address - Street 1:5784 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5702
Practice Address - Country:US
Practice Address - Phone:716-479-4506
Practice Address - Fax:716-871-1306
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR01806011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical