Provider Demographics
NPI:1679268965
Name:VOGEL, HEATHER (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:VOGEL
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 1:2150 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2020
Mailing Address - Country:US
Mailing Address - Phone:408-831-7762
Mailing Address - Fax:
Practice Address - Street 1:EXPANSIVE
Practice Address - Street 2:2150 NORTH 1ST STREET FIRST NOVEL COWORKING LLC
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131
Practice Address - Country:US
Practice Address - Phone:408-831-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical