Provider Demographics
NPI:1033494489
Name:OVALES, HEATHER JEAN
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:JEAN
Last Name:OVALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-5453
Mailing Address - Country:US
Mailing Address - Phone:321-362-0142
Mailing Address - Fax:
Practice Address - Street 1:1599 STAFFORD AVE
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-5453
Practice Address - Country:US
Practice Address - Phone:321-362-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker