Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 000147 | CT |
NPI | 1336213776 |
---|---|
Provider Name | Dr. Robert S. Henderson |
First Address | Glastonbury, CT 06033-3704 |
Second Address | South Glastonbury, CT 06073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2006 |
Last Update Date | 08/07/2007 |