Provider Demographics
NPI:1396619292
Name:MCKEOWN, HEATHER MARIE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:MCKEOWN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-4161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 TAYLOR LN
Practice Address - Street 2:
Practice Address - City:CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-4161
Practice Address - Country:US
Practice Address - Phone:609-827-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00270600101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty