Provider Demographics
NPI:1902058589
Name:HENDERSON, JANICE A (PHD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 GENERAL MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3529
Mailing Address - Country:US
Mailing Address - Phone:504-364-6600
Mailing Address - Fax:504-364-6651
Practice Address - Street 1:4460 GENERAL MEYER AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3529
Practice Address - Country:US
Practice Address - Phone:504-364-6613
Practice Address - Fax:504-364-6651
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA799103T00000X, 103TM1800X, 103TC0700X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral