Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | TP183-073 | NJ |
Y | 103TC0700X | Clinical Psychologist | TP183-073 | NJ |
N | 103TR0400X | Rehabilitation Psychologist | TP183-073 | NJ |
NPI | 1437620663 |
---|---|
Provider Name | Dr. Jarrett W. Henderson |
First Address | Pennington, NJ 08534-5246 |
Second Address | Pennington, NJ 08534-5246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2018 |
Last Update Date | 16/12/2018 |