Provider Demographics
NPI:1851426449
Name:HENDRICKS, STEVEN R (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 VESPER STREET
Mailing Address - Street 2:BOX 430
Mailing Address - City:BEECH CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16822-0430
Mailing Address - Country:US
Mailing Address - Phone:570-962-2922
Mailing Address - Fax:
Practice Address - Street 1:44 VESPER STREET
Practice Address - Street 2:BOX 430
Practice Address - City:BEECH CREEK
Practice Address - State:PA
Practice Address - Zip Code:16822-0430
Practice Address - Country:US
Practice Address - Phone:570-962-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-007225-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF79813Medicare UPIN
PA768930Medicare ID - Type Unspecified