Provider Demographics
NPI:1114544921
Name:SERAFIN, HEATHER JEAN (ACSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JEAN
Last Name:SERAFIN
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 153965
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92195-3965
Mailing Address - Country:US
Mailing Address - Phone:619-787-0180
Mailing Address - Fax:
Practice Address - Street 1:3990 OLD TOWN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2930
Practice Address - Country:US
Practice Address - Phone:619-278-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1183951041C0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical