Provider Demographics
NPI:1437343209
Name:DICK, HEATHER M (LCSW, NCSP)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:M
Last Name:DICK
Suffix:
Gender:F
Credentials:LCSW, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 SEBASCODEGAN SHORES RD
Mailing Address - Street 2:
Mailing Address - City:HARPSWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04079-4243
Mailing Address - Country:US
Mailing Address - Phone:207-319-4209
Mailing Address - Fax:
Practice Address - Street 1:98 SEBASCODEGAN SHORES RD
Practice Address - Street 2:
Practice Address - City:HARPSWELL
Practice Address - State:ME
Practice Address - Zip Code:04079-4243
Practice Address - Country:US
Practice Address - Phone:207-319-4209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME32261103TS0200X
MELC80191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical