Provider Demographics
NPI:1972719748
Name:HUTCHESON-SOUFAN, HEATHER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:HUTCHESON-SOUFAN
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 1:39 OLIVIA WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4269
Mailing Address - Country:US
Mailing Address - Phone:732-928-4842
Mailing Address - Fax:
Practice Address - Street 1:39 OLIVIA WAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4269
Practice Address - Country:US
Practice Address - Phone:732-928-4842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051786001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical