Provider Demographics
NPI:1013299940
Name:HENIGSON, VALERIE A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:A
Last Name:HENIGSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BOWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2808
Mailing Address - Country:US
Mailing Address - Phone:914-934-8062
Mailing Address - Fax:
Practice Address - Street 1:113 BOWMAN AVE
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2808
Practice Address - Country:US
Practice Address - Phone:914-934-8062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009876103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01406968Medicaid