Provider Demographics
NPI:1669791067
Name:GAUDETTE, HEATHER R (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:R
Last Name:GAUDETTE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 DOMINICUS CT
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-6462
Mailing Address - Country:US
Mailing Address - Phone:908-938-7053
Mailing Address - Fax:732-543-7308
Practice Address - Street 1:425 AMWELL RD STE 8
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1213
Practice Address - Country:US
Practice Address - Phone:908-938-7053
Practice Address - Fax:732-543-7308
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054255001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical