Provider Demographics
NPI:1912153933
Name:HENRIQUEZ, SUHADEE
Entity Type:Individual
Prefix:
First Name:SUHADEE
Middle Name:
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 48TH AVE
Mailing Address - Street 2:3006
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5501
Mailing Address - Country:US
Mailing Address - Phone:646-302-2126
Mailing Address - Fax:
Practice Address - Street 1:475 48TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11109-5501
Practice Address - Country:US
Practice Address - Phone:646-302-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-10
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool