Healthcare Provider Details

I. General information

NPI: 1962097733
Provider Name (Legal Business Name): CHELSEA HEACOCK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 WESTMINSTER ST NW
WASHINGTON DC
20001-4130
US

IV. Provider business mailing address

934 WESTMINSTER ST NW
WASHINGTON DC
20001-4130
US

V. Phone/Fax

Practice location:
  • Phone: 917-282-3395
  • Fax:
Mailing address:
  • Phone: 917-282-3395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104197
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: