Provider Demographics
NPI:1013363415
Name:KAMINSKI, HEIDI (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6627 W CARIBBEAN LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3161
Mailing Address - Country:US
Mailing Address - Phone:602-316-5155
Mailing Address - Fax:
Practice Address - Street 1:7747 W DEER VALLEY RD STE 255
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2124
Practice Address - Country:US
Practice Address - Phone:602-316-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW154361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical