Provider Demographics
NPI:1922306208
Name:CASSELLS-SIMPSON, HEATHER T
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:T
Last Name:CASSELLS-SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3053
Mailing Address - Country:US
Mailing Address - Phone:973-674-0092
Mailing Address - Fax:
Practice Address - Street 1:11 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3053
Practice Address - Country:US
Practice Address - Phone:973-674-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0364671101YS0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool