Provider Demographics
NPI:1811485857
Name:HENZEL, TAYLOR (MED)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:
Last Name:HENZEL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MISS
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:PAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1601
Mailing Address - Country:US
Mailing Address - Phone:201-388-8843
Mailing Address - Fax:
Practice Address - Street 1:900C LAKE ST STE 3
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1281
Practice Address - Country:US
Practice Address - Phone:201-388-8843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00412400101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty