Provider Demographics
NPI:1194208702
Name:CORREA, HEIDY CONSEPCION (ASW, MSW)
Entity Type:Individual
Prefix:
First Name:HEIDY
Middle Name:CONSEPCION
Last Name:CORREA
Suffix:
Gender:F
Credentials:ASW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11947 VALLEY VIEW ST UNIT 6403
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92846-6554
Mailing Address - Country:US
Mailing Address - Phone:714-896-7566
Mailing Address - Fax:
Practice Address - Street 1:14140 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4453
Practice Address - Country:US
Practice Address - Phone:714-896-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW920211041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical