Provider Demographics
NPI:1982789558
Name:HENDRICKSON, HELEN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:ELIZABETH
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N GUADALUPE ST # 169
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1868
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 CERRILLOS ROAD
Practice Address - Street 2:SUITE #719F
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2699
Practice Address - Country:US
Practice Address - Phone:505-500-4072
Practice Address - Fax:505-216-2219
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000256542084P0800X
NMMD2010-06292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA217000578Medicare ID - Type Unspecified
WAE87932Medicare UPIN