Provider Demographics
NPI:1285635516
Name:HEATH, CAROLYN SUE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:SUE
Last Name:HEATH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 W POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3217
Mailing Address - Country:US
Mailing Address - Phone:717-258-0214
Mailing Address - Fax:717-258-3158
Practice Address - Street 1:47 W POMFRET ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3217
Practice Address - Country:US
Practice Address - Phone:717-258-0214
Practice Address - Fax:717-258-3158
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA014772101YM0800X, 101YP1600X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012248330001Medicaid
PA50047763OtherCAPITAL BLUE CROSS
PA810554001OtherAETNA
PA810554001OtherMAIL HANDLERS
PA810554001OtherQUEST
PA810554001OtherUNITED BEHAVIORAL HLTH
PA810554001OtherHIGHMARK FEDERAL
PA128194OtherVALUE OPTIONS
PA195761000OtherMAGELLAN
PA2033298OtherCIGNA
PA250976OtherCOMPSYCH
PA810554001OtherALLIANCE WORK PARTNERS
PA810554001OtherHEALTHNET TRICARE
PA810554001OtherPRIME SOURCE
PA810554001OtherTEAM EAP
PA1012248330001Medicaid