Provider Demographics
NPI:1710103577
Name:HEATH, TONIA (LCSW)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:HEATH
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 1:241 E LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4717
Mailing Address - Country:US
Mailing Address - Phone:831-688-8856
Mailing Address - Fax:831-728-3629
Practice Address - Street 1:2716 FREEDOM BLVD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-1027
Practice Address - Country:US
Practice Address - Phone:831-688-8856
Practice Address - Fax:831-728-3629
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18928104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ92069ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#