Provider Demographics
NPI:1356556203
Name:BECKER-SHARE, HEIDI GAIL (MSW,ACSW,LSW,QCSW)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:GAIL
Last Name:BECKER-SHARE
Suffix:
Gender:F
Credentials:MSW,ACSW,LSW,QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLYN
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1517
Mailing Address - Country:US
Mailing Address - Phone:856-287-5400
Mailing Address - Fax:
Practice Address - Street 1:328 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:OAKLYN
Practice Address - State:NJ
Practice Address - Zip Code:08107-1517
Practice Address - Country:US
Practice Address - Phone:856-287-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW003289E104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker