Individual provider Active NPI

Kathryn Lynn Henderson, PHD, LPC, NCC

  • Professional Counselor
  • West Hartford, CT
National Provider Identifier
1336715127
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
003705 Issued in CT
Practice address
784 Farmington Ave
West Hartford, CT 06119-1619
Phone
(860) 523-4450
Fax
(860) 523-9537
NPI assigned
Jun 2, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 003705 CT Primary

Addresses

Primary practice location

784 Farmington Ave
West Hartford, CT 06119-1619

Mailing address

49 Welles Dr N
Newington, CT 06111-2618
Phone (504) 723-8740

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241120001988 CT Practitioner - Mental Health Counselor 6901338649 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

784 Farmington Ave
West Hartford, CT 06119-1619
Phone (860) 245-9077

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
003705CTMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Women'S Center for Psychotherapy,LLC CurrentSince Jun 6, 2021 Accepting new patients
Clementine Counseling Professional CurrentSince Oct 6, 2024 Accepting new patients

Locations

784 Farmington Ave
West Hartford, CT 06119
Phone (860) 245-9077

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1622592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1336715127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 WELLES DR N",
            "city": "NEWINGTON",
            "state": "CT",
            "postal_code": "061112618",
            "telephone_number": "504-723-8740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "784 FARMINGTON AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061191619",
            "telephone_number": "860-523-4450",
            "fax_number": "860-523-9537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KATHRYN",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "PHD, LPC, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-02",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "003705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

Verify at the official NPI Registry.