Provider Demographics
NPI:1790844645
Name:HENDRICKEN, MARION DIANE (LMHC)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:DIANE
Last Name:HENDRICKEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:M
Other - Middle Name:DIANE
Other - Last Name:HENDRICKEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:20 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1942
Mailing Address - Country:US
Mailing Address - Phone:508-393-4473
Mailing Address - Fax:508-393-4473
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1942
Practice Address - Country:US
Practice Address - Phone:508-393-4473
Practice Address - Fax:508-393-4473
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health