Provider Demographics
NPI:1013112572
Name:HENDRICKS, GRETCHEN JENNIFER (PHD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:JENNIFER
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-586-5575
Mailing Address - Fax:413-586-5575
Practice Address - Street 1:155 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-586-5575
Practice Address - Fax:413-586-5575
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7176103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05718OtherBCBS
MA0005330639OtherAETNA
MA6142569OtherUNITED HEALTHCARE
MAW05718Medicaid
MA127472OtherTRICARE CHAMPUS
MA74315774201OtherHARVARD PILGRIM
MA018742OtherVMC BEHAVIORAL HEALTHCARE
MA127472OtherVALUE OPTIONS
MA74315774201OtherPACIFICARE
MA400456OtherTUFTS
MA6142456OtherUNITED BEHAVIORAL HEALTH
MAA002419OtherTRICARE CHAMPUS
MA127472OtherVALUE OPTIONS