Provider Demographics
NPI:1679266936
Name:HEYWOOD, AVERY SIERRA (MSW)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:SIERRA
Last Name:HEYWOOD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:AVERY
Other - Middle Name:
Other - Last Name:BASIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1305 W CHESTER PIKE STE 18
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2929
Mailing Address - Country:US
Mailing Address - Phone:215-346-6684
Mailing Address - Fax:
Practice Address - Street 1:1959 WEST SPARKS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-346-6684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health