Edward Bruce Henderson, PHD, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

939 W Sunnyside Ave
#1W
Chicago, IL 60640-6967

Phone

(773) 344-5072

Fax

(773) 978-3005

NPI assigned

Oct 15, 2007

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)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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

• Rehab Services SL, S.C.

  • Psychiatry Physician
  • Chicago, IL
  • NPI 1982932497
  NPD (past)

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192406400000",
    "number": "1326237447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "939 W SUNNYSIDE AVE",
            "address_2": "#1W",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606406967",
            "telephone_number": "773-344-5072",
            "fax_number": "773-978-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 W SUNNYSIDE AVE",
            "address_2": "#1W",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606406967",
            "telephone_number": "773-344-5072",
            "fax_number": "773-978-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "EDWARD",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "PHD, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-15",
        "last_updated": "2007-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chique Henderson
• Claire Henderson, LSW
• Claudette Henderson, LCSW
• Cynthia Henderson, M.D.
• Daunte Martez Henderson, LCSW
• Elena Kelsey Henderson, PHD
• Germaine M Henderson
• Heather Henderson, RN BSN IBCLC
• Jordan Seville Henderson, LPC
• Joseph R Henderson

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; 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.