Provider Demographics
NPI:1689953994
Name:HEDDERMAN, AMY DAWN (MSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DAWN
Last Name:HEDDERMAN
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11679 EMERALD GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-5337
Mailing Address - Country:US
Mailing Address - Phone:301-704-3598
Mailing Address - Fax:
Practice Address - Street 1:11679 EMERALD GREEN DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-5337
Practice Address - Country:US
Practice Address - Phone:301-704-3598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD169051041C0700X
DCLC500789451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical