Provider Demographics
NPI:1437785789
Name:CHURCH-SOTO, HEATHER M (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:CHURCH-SOTO
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 1:570 SICA LN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8216
Mailing Address - Country:US
Mailing Address - Phone:732-908-2383
Mailing Address - Fax:
Practice Address - Street 1:970 ROUTE 70
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3502
Practice Address - Country:US
Practice Address - Phone:347-728-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053554001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical