Provider Demographics
NPI:1376801324
Name:BENSE, HEATHER (LCSW)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:BENSE
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 1:505 HAMILTON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1059
Mailing Address - Country:US
Mailing Address - Phone:609-800-4133
Mailing Address - Fax:
Practice Address - Street 1:505 HAMILTON AVE. SUITE 203
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221
Practice Address - Country:US
Practice Address - Phone:609-800-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2022-07-15
Deactivation Date:2020-12-04
Deactivation Code:
Reactivation Date:2020-12-10
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055594001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ320091BTMMedicare PIN