Basic Information
| Provider Information | |||||||||
| NPI: | 1346484599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIFFE | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3605 VISTA WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609677082 | ||||||||
| FaxNumber: | 7609671465 | ||||||||
| Practice Location | |||||||||
| Address1: | 3605 VISTA WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609677082 | ||||||||
| FaxNumber: | 7609671465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2009 | ||||||||
| LastUpdateDate: | 06/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 22332 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 26696 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.