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Individual
DR. MARY ELLEN HENRY
Active
Individual
DR. MARY ELLEN HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.,LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1028357
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1858483
MASSHEALTH PROVIDER NUMBE
MA
05
—
1894862
—
MA
01
—
P07319
BLUE CROSS PROVIDER NUMBE
MA
Enumeration date
02/16/2007
Last updated
07/09/2007
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