Myra Anita Henderson, LISW-SUPV

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I0007669 SUPV Issued in OH

Practice address

29343 Euclid Ave
Wickliffe, OH 44092-1958

Phone

(216) 299-0398

NPI assigned

Jan 24, 2013

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Myra A Thomas Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1358985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1962740035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 BELMONT RD",
            "city": "WOODMERE",
            "state": "OH",
            "postal_code": "441224509",
            "telephone_number": "216-299-0398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29343 EUCLID AVE",
            "city": "WICKLIFFE",
            "state": "OH",
            "postal_code": "440921958",
            "telephone_number": "216-299-0398"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "966 E 146th St",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441103729",
            "country_code": "US",
            "telephone_number": "216-851-1853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MYRA",
        "middle_name": "ANITA",
        "name_prefix": "Mrs.",
        "credential": "LISW-SUPV",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I0007669 SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MYRA",
            "last_name": "THOMAS",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Wickliffe, OH
• Providers in Wickliffe, 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 17, 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.