Provider Demographics
NPI:1720272719
Name:HEROUX, ELAINE MARILYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARILYN
Last Name:HEROUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18081 SE COUNTRY CLUB DR
Mailing Address - Street 2:APT. 103
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-1276
Mailing Address - Country:US
Mailing Address - Phone:561-277-8326
Mailing Address - Fax:561-744-2807
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-6918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-01
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW87081041C0700X
MSC70931041C0700X
TNLSW38431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125094Medicaid
TN3921555Medicare PIN