Provider Demographics
NPI:1730464298
Name:HENRY, NADINE ANN-MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NADINE
Middle Name:ANN-MARIE
Last Name:HENRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NADINE
Other - Middle Name:ANN-MARIE
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:449 W SILVER STAR RD UNIT 669
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-8027
Mailing Address - Country:US
Mailing Address - Phone:407-446-2223
Mailing Address - Fax:844-927-4534
Practice Address - Street 1:5401 S KIRKMAN RD STE 310
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7937
Practice Address - Country:US
Practice Address - Phone:407-337-3160
Practice Address - Fax:844-927-4534
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1075103T00000X, 103TS0200X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty