Provider Demographics
NPI:1780008193
Name:BABCOCK, HEATHER (LCSW-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BABCOCK
Suffix:
Gender:F
Credentials: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:PSC 561 BOX 1877
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96310-0016
Mailing Address - Country:US
Mailing Address - Phone:0118146-816-8658
Mailing Address - Fax:0118146-816-8650
Practice Address - Street 1:PSC 561 BOX 1877
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96310-0016
Practice Address - Country:US
Practice Address - Phone:0118146-816-8658
Practice Address - Fax:0118146-816-8650
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD169131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical