Healthcare Provider Details

I. General information

NPI: 1467731166
Provider Name (Legal Business Name): CAITLIN HEFFERNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7474 GREENWAY CENTER DR SUITE 730
GREENBELT MD
20770-3504
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR SUITE 730
GREENBELT MD
20770-3504
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-1022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17198
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: