Myra Anita Henderson, LISW-SUPV
Individual provider Active NPI Clinical Social Worker · Wickliffe, OH
NPI 1962740035 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1962740035
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- I0007669 SUPV (OH)
- Practice address
- 29343 Euclid Ave
Wickliffe, OH 44092-1958 - Phone
- (216) 299-0398
- NPI assigned
- Jan 24, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I0007669 SUPV | OH | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I0007669 SUPV | OH | Yes |
Addresses
Primary practice location
29343 Euclid Ave
Wickliffe, OH 44092-1958
Mailing address
3707 Belmont Rd
Woodmere, OH 44122-4509
Phone (216) 299-0398
Other practice location 1
966 E 146th St
Cleveland, OH 44110-3729
Phone (216) 851-1853
Other names
- Myra A Thomas
Other providers in Wickliffe, OH
- Jeanne Hall
- Kiki Hardy
- Healthy Homecare Adlut Daycare
- Healthy Solutions, Inc.
- Heartfelt Heroes LLC
- Leah Elaine Hollins
- Ashley Virginia Howard
- Melissa Howell
- Hanna Lynn Hromulak
- Rachel Elaine Ignasiak
All providers in Wickliffe, OH · Clinical Social Worker in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.