Basic Information
| Provider Information | |||||||||
| NPI: | 1689990970 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEATHER D REDMOND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 HARVARD RD | ||||||||
| Address2: | |||||||||
| City: | PORT MATILDA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168707307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149377686 | ||||||||
| FaxNumber: | 8143170341 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 WILSON AVE | ||||||||
| Address2: | |||||||||
| City: | ROARING SPRING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166731351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149377686 | ||||||||
| FaxNumber: | 8143170341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2010 | ||||||||
| LastUpdateDate: | 04/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | REDMOND | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED CLINICAL SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 8149377686 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.