Provider Demographics
NPI:1205553450
Name:HENDERSON, SARAH SHAMIYA KHIARA (LMSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:SHAMIYA KHIARA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 GENESEE ST APT A1
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-1244
Mailing Address - Country:US
Mailing Address - Phone:585-503-0319
Mailing Address - Fax:
Practice Address - Street 1:9221 ROBERT HART DR
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-8931
Practice Address - Country:US
Practice Address - Phone:585-335-4316
Practice Address - Fax:585-335-3277
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health