Provider Demographics
NPI:1366632267
Name:HEITH, JOANNE MAUDE (PSYD,LCSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MAUDE
Last Name:HEITH
Suffix:
Gender:F
Credentials:PSYD,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 CARLTON AVE
Mailing Address - Street 2:#2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4032
Mailing Address - Country:US
Mailing Address - Phone:718-707-1588
Mailing Address - Fax:
Practice Address - Street 1:214 CARLTON AVE
Practice Address - Street 2:#2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4032
Practice Address - Country:US
Practice Address - Phone:718-707-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049696-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN2T661Medicare PIN