Provider Demographics
NPI:1437766565
Name:ALBERTSON, HEATHER (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ALBERTSON
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 1:100 SCHOOL STREET
Mailing Address - Street 2:SONORA UNION HIGH SCHOOL DISTRICT
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5680
Mailing Address - Country:US
Mailing Address - Phone:209-533-8510
Mailing Address - Fax:
Practice Address - Street 1:430 NORTH WASHINGTON STREET
Practice Address - Street 2:SONORA HIGH SCHOOL
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-533-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85425101Y00000X
CA1042511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor