Provider Demographics
NPI:1871668418
Name:HENDERSON-ALDRIDGE, MARTRICE DENISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARTRICE
Middle Name:DENISE
Last Name:HENDERSON-ALDRIDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARTRICE
Other - Middle Name:
Other - Last Name:ALDRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2990 N PERRYVILLE RD UNIT 4100A
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6827
Mailing Address - Country:US
Mailing Address - Phone:815-975-3330
Mailing Address - Fax:779-423-1761
Practice Address - Street 1:2990 N PERRYVILLE RD UNIT 4100A
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6827
Practice Address - Country:US
Practice Address - Phone:815-975-3330
Practice Address - Fax:779-423-1761
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490078721041C0700X
TX1106071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL581740Medicare ID - Type Unspecified