Provider Demographics
NPI:1053603209
Name:HEATH, WILLIAM (LSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HEATH
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CROSS KEYS RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9201
Mailing Address - Country:US
Mailing Address - Phone:856-210-1511
Mailing Address - Fax:
Practice Address - Street 1:128 CROSS KEYS RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9201
Practice Address - Country:US
Practice Address - Phone:856-210-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05549400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker