1457629826 NPI number — ELISABETH CHRISTINA HEIJ MSW,LSW

Table of content: ELISABETH CHRISTINA HEIJ MSW,LSW (NPI 1457629826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457629826 NPI number — ELISABETH CHRISTINA HEIJ MSW,LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIJ
Provider First Name:
ELISABETH
Provider Middle Name:
CHRISTINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW,LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEIJ
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
CHRISTINA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457629826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 WYCOFF LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18337-5109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-228-1485
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 WYCOFF LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18337-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-228-1485
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2011

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: 1041C0700X , with the licence number:  CW 017850 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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