Provider Demographics
NPI:1952528994
Name:DODDS, HEATHER WILDER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:WILDER
Last Name:DODDS
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 1:14 HANCOCK LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2912
Mailing Address - Country:US
Mailing Address - Phone:908-447-9226
Mailing Address - Fax:
Practice Address - Street 1:39 AVENUE AT THE CMN STE 106
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4560
Practice Address - Country:US
Practice Address - Phone:908-447-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052834001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical