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NPI Code Detail

MEDICARE: HEATHER ANNE RADCLIFFE LICSW ACSW

MEDICARE: HEATHER ANNE RADCLIFFE LICSW ACSW
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
11041C0700XClinical Social WorkerDP00941015WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649539396
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER ANNE RADCLIFFE LICSW ACSW
Provider Business Mailing Address
First Line : 65 PROFESSIONAL PL STE 102103
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-0258
Country : US
Telephone Number : 304-848-5770
Fax Number : 304-848-0980
Provider Business Practice Location Address
First Line : 65 PROFESSIONAL PL STE 102103
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-0258
Country : US
Telephone Number : 304-848-5770
Fax Number : 304-848-0980
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2012
Last Update Date : 09/07/2022

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Directions to “ HEATHER ANNE RADCLIFFE LICSW ACSW” Practice Location

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