Provider Demographics
NPI:1245442649
Name:HEINEMEYER, CARL PAUL (LCSW)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:PAUL
Last Name:HEINEMEYER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 OLD SHERMAN TPKE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4174
Mailing Address - Country:US
Mailing Address - Phone:203-240-6303
Mailing Address - Fax:
Practice Address - Street 1:7 OLD SHERMAN TPKE
Practice Address - Street 2:SUITE 205
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4174
Practice Address - Country:US
Practice Address - Phone:203-240-6303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0030641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical