Provider Demographics
NPI:1508973876
Name:HEFFNER, SUSAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:HEFFNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 BELLEVUE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3500
Mailing Address - Country:US
Mailing Address - Phone:401-849-5600
Mailing Address - Fax:
Practice Address - Street 1:226 BELLEVUE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3500
Practice Address - Country:US
Practice Address - Phone:401-849-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW016411041C0700X
RI1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool