Brianna Henderson, LICDC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2103248 Issued in OH

Practice address

4977 Northcutt PL
Dayton, OH 45414-3839

Phone

(937) 387-6395

NPI assigned

Apr 23, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Family Resource Center of Northwest Ohio Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lima, OH
  • NPI 1710930953

  Single Specialty

  Medicare reassignment NPD
• Sequoia Wellness Center LLC

  • Professional Counselor
  • Lima, OH
  • NPI 1962239921
  Medicare reassignment

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

{
    "created_epoch": "1524441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1609363928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1566 W WAYNE ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458052272",
            "telephone_number": "419-296-3330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4977 NORTHCUTT PL",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454143839",
            "telephone_number": "937-387-6395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "BRIANNA",
        "credential": "LICDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-23",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2103248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "341475943",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Allen Hemsley, DO
• Jessica Hendershot, PEER SUPPORT
• Meagan-Helen Henderson Berg, MDCM (MD)
• Aaron Henderson
• Brandy Davina Henderson, RN,FNP, PMHNP
• Candice Anne Henderson
• Cheron M Henderson, LPN
• Coleen Henderson, LISW-S
• Daniel Henderson, PEER SUPPORT
• Justin Luvalle Henderson, BSW,MSW

• Clinical Social Worker in Dayton, OH
• Providers in Dayton, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.