Provider Demographics
NPI:1669412177
Name:SUSAN H MCHENRY
Entity type:Organization
Organization Name:SUSAN H MCHENRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:HENDERSON
Authorized Official - Last Name:MCHENRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-751-2058
Mailing Address - Street 1:13104 POPLAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2048
Mailing Address - Country:US
Mailing Address - Phone:301-751-2058
Mailing Address - Fax:301-632-9595
Practice Address - Street 1:13104 POPLAR HILL RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2048
Practice Address - Country:US
Practice Address - Phone:301-751-2058
Practice Address - Fax:301-632-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD105081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2273367OtherCIGNA BEHAVIORAL PROV NUM
MD100089335OtherAPS HEALTHCARE PROV NUM
MD1133183OtherAETNA PROVIDER NUMBER
MD217-64-9471OtherTRICARE PRIME PROV NUM
MD371103OtherMHN PROVIDER NUM
MD239C,64703301OtherBCBS OF MD PROVIDER NUM
MD5677OtherBCBS FEDERAL PROVIDER NUM
MD5677OtherBCBS OF DC PROVIDER NUM
MD217649471OtherTRICARE STANDARD PPO NUM
MD740207OtherNCPPO PROVIDER NUM
MD371103OtherMHN PROVIDER NUM
MD289PMedicare ID - Type UnspecifiedMEDICARE NUMBER FOR OHCC