Provider Demographics
NPI:1073930319
Name:SMITH, HEIDI (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:SMITH
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 1:96 FEDERAL TWIST RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559-1808
Mailing Address - Country:US
Mailing Address - Phone:856-745-8703
Mailing Address - Fax:
Practice Address - Street 1:361 ROUTE 31
Practice Address - Street 2:BLDG D, SUITE 1101
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5796
Practice Address - Country:US
Practice Address - Phone:856-745-8703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052611001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical