Provider Demographics
NPI:1437620663
Name:HENDERSON, JARRETT W (PSYD)
Entity type:Individual
Prefix:DR
First Name:JARRETT
Middle Name:W
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3118
Mailing Address - Country:US
Mailing Address - Phone:803-804-8688
Mailing Address - Fax:
Practice Address - Street 1:2453 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3118
Practice Address - Country:US
Practice Address - Phone:803-804-8688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017825101YP2500X
NJTP183-073103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional