MEDICARE: BRENDA ANN HEFLIN 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	1041C0700X	Clinical Social Worker	LCSW93466	CA

General Provider Information

NPI Number	:	1700510328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA ANN HEFLIN LCSW

Provider Business Mailing Address
First Line	:	823 GATEWAY CENTER WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-4541
Country	:	US
Telephone Number	:	619-515-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	7290 EL CAJON BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-1829
Country	:	US
Telephone Number	:	619-255-7705
Fax Number	:

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

Provider Enumeration Date	:	07/11/2022
Last Update Date	:	08/21/2023

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