Provider Demographics
NPI:1811540891
Name:HENRY, HEATHER (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:JENEVE
Other - Last Name:HENRY-IGNACIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:RAF LAKENHEATH
Mailing Address - Street 2:CHESTER STREET
Mailing Address - City:BRANDON
Mailing Address - State:LAKENHEATH
Mailing Address - Zip Code:IP27 9PS
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RAF LAKENHEATH
Practice Address - Street 2:BRANDON RD
Practice Address - City:LAKENHEATH
Practice Address - State:SUFFOLK
Practice Address - Zip Code:IP27 9PS
Practice Address - Country:GB
Practice Address - Phone:240-810-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06173361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical