Provider Demographics
NPI:1326800558
Name:ALLEN, HEATHER (MSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 THOROUGHBRED WAY
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7660
Mailing Address - Country:US
Mailing Address - Phone:563-299-1394
Mailing Address - Fax:
Practice Address - Street 1:404 THOROUGHBRED WAY
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7660
Practice Address - Country:US
Practice Address - Phone:563-299-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW194341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical