Provider Demographics
NPI:1659706372
Name:MCGOVERN, HEATHER ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ROSE
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ROSE-MCGOVERN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2 SAINT REGIS DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-4641
Mailing Address - Country:US
Mailing Address - Phone:850-377-0212
Mailing Address - Fax:
Practice Address - Street 1:2 SAINT REGIS DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-4641
Practice Address - Country:US
Practice Address - Phone:850-377-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X
FLSW196101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker