Most Relevant Information
Provider Data
| NPI Number: | 1003452640 |
| Provider Name: | JOHNASTASIA LILLIAN HENDERSON MS |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/19/2019 |
| Last Updated: | 11/19/2019 |
Provider Practice Location
33 OAK AVE
WORCESTER
MA
016052752
Practice Location Phone/Fax
| Phone: | 7744028800 |
| Fax: | 7744202804 |
Provider Mailing Location
125 LIBERTY ST STE 204
SPRINGFIELD
MA
011031109
Provider Mailing Phone/Fax
| Phone: | 4132717136 |
| Fax: | 4132717137 |