1215138300 NPI number — HEATHER LINDO MSW, LCSW, C-ACYFSW

Table of content: (NPI 1861906067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215138300 NPI number — HEATHER LINDO MSW, LCSW, C-ACYFSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDO
Provider First Name:
HEATHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, C-ACYFSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLARD
Provider Other First Name:
HEATHER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW, C-ACYFSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215138300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4327 S HWY 27
Provider Second Line Business Mailing Address:
PMB 203
Provider Business Mailing Address City Name:
CLERMONT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-706-4528
Provider Business Mailing Address Fax Number:
704-749-8612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4327 S. HWY 27
Provider Second Line Business Practice Location Address:
PMB 203
Provider Business Practice Location Address City Name:
CLERMONT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-402-0291
Provider Business Practice Location Address Fax Number:
704-749-8612
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 193400000X , with the licence number:  SW13438 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: SW13438 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0248052-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6106388 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 024805200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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