Individual
DR. DENNIS MALCOLM HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
12 GILDARE DRIVE, GAST NORTHPORT, NY 11731-3223
(631) 368-8502
(631) 368-8502
Mailing address
12 GILDARE DRIVE, GAST NORTHPORT, NY 11731-3223
(631) 368-8502
(631) 368-8502
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
011792-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01660737
—
NY
01
—
S11729-9
WORKERS COMP ON SATION
NY
Enumeration date
08/28/2006
Last updated
07/08/2007
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