Bruce Henry, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

ME20145 Issued in FL

Practice address

101 Louise Ave
New Smyrna Beach, FL 32168-6208

Phone

(386) 689-6981

Fax

(386) 424-0157

NPI assigned

Mar 24, 2006

Last updated

May 4, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifestream Behavioral Center Inc

  • Primary Care Clinic/Center
  • Leesburg, FL
  • NPI 1659613776
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525392000000",
    "number": "1114987211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 LOUISE AVE",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321686208",
            "telephone_number": "386-689-6981",
            "fax_number": "386-424-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 LOUISE AVE",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321686208",
            "telephone_number": "386-689-6981",
            "fax_number": "386-424-0157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "BRUCE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2018-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME20145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heart Strings Boutique LLC
• Bryan Henry Heath, M.D.
• Chelsea Elyse Heck, OD
• Michelle Suzanne Hedderich, M.D.
• Brianna Hennen
• Jennifer Lee Henry, D.C.
• George Fredrick Herdel III, M.D.
• William Randolph Herman, LCSW
• Lafe Hernandez, DC
• Ilze Hicks, M.D.

• Child & Adolescent Psychiatry Physician in New Smyrna Beach, FL
• Providers in New Smyrna Beach, FL by specialty
• Child & Adolescent Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.