Provider Demographics
NPI:1912506379
Name:MUTZEN, HENNA
Entity Type:Individual
Prefix:
First Name:HENNA
Middle Name:
Last Name:MUTZEN
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 1:5 LANE ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-4036
Mailing Address - Country:US
Mailing Address - Phone:917-626-6470
Mailing Address - Fax:
Practice Address - Street 1:5 LANE ST UNIT 201
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-4036
Practice Address - Country:US
Practice Address - Phone:917-626-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-18
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 171M00000X
NY1406151201252Y00000X
NY1-20-43961103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist
No252Y00000XAgenciesEarly Intervention Provider Agency
No171M00000XOther Service ProvidersCase Manager/Care Coordinator