Provider Demographics
NPI:1295120350
Name:HENRY, AMYRA W (MSW)
Entity type:Individual
Prefix:
First Name:AMYRA
Middle Name:W
Last Name:HENRY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2847 IDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1125
Mailing Address - Country:US
Mailing Address - Phone:847-380-2591
Mailing Address - Fax:312-857-1157
Practice Address - Street 1:1866 SHERIDAN RD
Practice Address - Street 2:SUITE 305
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2547
Practice Address - Country:US
Practice Address - Phone:847-380-2591
Practice Address - Fax:312-857-1157
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-05
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490017081041C0700X
IL11434481041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool