Provider Demographics
NPI:1831107937
Name:HENDERSON, DENISE W (MD/ABPN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:W
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD/ABPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 SUNRISE VISTA DR
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7053
Mailing Address - Country:US
Mailing Address - Phone:916-721-8100
Mailing Address - Fax:916-721-8117
Practice Address - Street 1:6060 SUNRISE VISTA DR
Practice Address - Street 2:SUITE 2200
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7053
Practice Address - Country:US
Practice Address - Phone:916-721-8100
Practice Address - Fax:916-721-8117
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA067876103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH17168Medicare UPIN