Provider Demographics
NPI:1902477102
Name:HENDERSON, JOSEPH GREGORY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:GREGORY
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 BOUNDARY BAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-9114
Mailing Address - Country:US
Mailing Address - Phone:317-919-7147
Mailing Address - Fax:
Practice Address - Street 1:3717 BOUNDARY BAY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-9114
Practice Address - Country:US
Practice Address - Phone:317-919-7147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008462A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical