Provider Demographics
NPI:1801290713
Name:HENRY, CONNITA (LCSW)
Entity type:Individual
Prefix:
First Name:CONNITA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CONNITA
Other - Middle Name:
Other - Last Name:SMOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4755 OGLETOWN STANTON RD STE 1915
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2200
Mailing Address - Country:US
Mailing Address - Phone:302-733-6662
Mailing Address - Fax:302-733-2372
Practice Address - Street 1:4755 OGLETOWN STANTON RD STE 1915
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-6662
Practice Address - Fax:302-733-2372
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG12055104100000X
DEQ3-00001661041C0700X
DEQ1-00119661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker