Provider Demographics
NPI:1750643797
Name:HENRY, KATHLEEN (MS,SPEC ED)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS,SPEC ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6535 BROADWAY
Mailing Address - Street 2:2 K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2012
Mailing Address - Country:US
Mailing Address - Phone:917-617-0344
Mailing Address - Fax:347-326-5353
Practice Address - Street 1:6535 BROADWAY
Practice Address - Street 2:2 K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2012
Practice Address - Country:US
Practice Address - Phone:917-617-0344
Practice Address - Fax:347-326-5353
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist