Provider Demographics
NPI:1891791554
Name:HENRY, ROBERT BRUCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:HENRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5846 N SAINT JOHNS CT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6047
Mailing Address - Country:US
Mailing Address - Phone:847-619-6499
Mailing Address - Fax:877-700-8148
Practice Address - Street 1:1821 WALDEN OFFICE SQ
Practice Address - Street 2:STE 400
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4273
Practice Address - Country:US
Practice Address - Phone:847-925-5115
Practice Address - Fax:877-700-8148
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-002757103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1673008OtherBC/BS OF ILLINOIS
IL328580Medicare ID - Type Unspecified