Provider Demographics
NPI:1245428655
Name:DICK, HEATHER ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANN
Last Name:DICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3206
Mailing Address - Country:US
Mailing Address - Phone:570-772-1864
Mailing Address - Fax:
Practice Address - Street 1:270 WALKER DR STE 331E
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7097
Practice Address - Country:US
Practice Address - Phone:814-933-4622
Practice Address - Fax:814-690-1599
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053403001041C0700X
MELC177411041C0700X
VT089.01341621041C0700X
PACW0173531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical