Provider Demographics
NPI:1962006015
Name:HENAINE, NATHALIE R (MA, PSYD)
Entity Type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:R
Last Name:HENAINE
Suffix:
Gender:F
Credentials:MA, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2638 N WASHTENAW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1836
Mailing Address - Country:US
Mailing Address - Phone:773-972-6178
Mailing Address - Fax:
Practice Address - Street 1:3448 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-9740
Practice Address - Country:US
Practice Address - Phone:773-245-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health