Provider Demographics
NPI:1457629826
Name:HEIJ, ELISABETH CHRISTINA (MSW,LSW)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:CHRISTINA
Last Name:HEIJ
Suffix:
Gender:F
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CHRISTINA
Other - Last Name:HEIJ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104 WYCOFF LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-5109
Mailing Address - Country:US
Mailing Address - Phone:570-228-1485
Mailing Address - Fax:
Practice Address - Street 1:104 WYCOFF LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-5109
Practice Address - Country:US
Practice Address - Phone:570-228-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW 0178501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical