Provider Demographics
NPI:1841747912
Name:VICQUERY, HEATHER MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:VICQUERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:BAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:55 JENKINS ST
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1711
Mailing Address - Country:US
Mailing Address - Phone:516-459-3603
Mailing Address - Fax:516-568-3072
Practice Address - Street 1:55 JENKINS ST
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1711
Practice Address - Country:US
Practice Address - Phone:516-459-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098621171M00000X
NY0939331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator