Provider Demographics
NPI:1821379678
Name:DAVID HENRY, PH.D.
Entity Type:Organization
Organization Name:DAVID HENRY, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF EMPLOYER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-423-1352
Mailing Address - Street 1:8 ADELINE PL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1656
Mailing Address - Country:US
Mailing Address - Phone:860-423-1352
Mailing Address - Fax:
Practice Address - Street 1:207 STORRS RD
Practice Address - Street 2:P.O. 740
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1638
Practice Address - Country:US
Practice Address - Phone:860-428-4103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty