Provider Demographics
NPI:1083098818
Name:PAGE, HEATHER K
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:PAGE
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 1:3332 S SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2517
Mailing Address - Country:US
Mailing Address - Phone:619-395-2479
Mailing Address - Fax:
Practice Address - Street 1:3332 S SEMORAN BLVD
Practice Address - Street 2:APT 12
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2517
Practice Address - Country:US
Practice Address - Phone:619-395-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical