Theresa M Henderson, PA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW2072 Issued in FL

Legal business name

THERESA M HENDERSON, PA

Practice address

1210 Millennium Pkwy
Suite 1035
Brandon, FL 33511-4861

Phone

(813) 716-0585

Fax

(813) 814-0448

NPI assigned

Mar 14, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Theresa M Henderson, LCSWNPI 1326149014

Title

President

Phone

(813) 716-0585

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theresa M Henderson, LCSW

  • Clinical Social Worker
  • Brandon, FL
  • NPI 1326149014
  NPD (past) Authorized official

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

{
    "created_epoch": "1331683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332892800000",
    "number": "1982979662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9609 WOODBAY DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336262422",
            "telephone_number": "813-716-0585",
            "fax_number": "813-814-0448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 MILLENNIUM PKWY",
            "address_2": "SUITE 1035",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114861",
            "telephone_number": "813-716-0585",
            "fax_number": "813-814-0448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERESA M HENDERSON, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-14",
        "last_updated": "2012-03-28",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-716-0585",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW2072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Brandon, FL
• Providers in Brandon, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; 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.