Provider Demographics
NPI:1134851603
Name:KOSCHMANN, HEATHER ELAINE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELAINE
Last Name:KOSCHMANN
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 1:3221 CARTER AVE UNIT 237
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-4953
Mailing Address - Country:US
Mailing Address - Phone:602-670-7516
Mailing Address - Fax:
Practice Address - Street 1:65 N WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-3119
Practice Address - Country:US
Practice Address - Phone:570-606-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASWG132076104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker