MEDICARE: HEATHER M. DINNEEN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	LCSW64854	CA

General Provider Information

NPI Number	:	1588810345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER M. DINNEEN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 6468
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-5168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	744 SAN ANTONIO RD STE 28
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94303-4624
Country	:	US
Telephone Number	:	650-352-3227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	01/07/2015

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