Healthcare Provider Details

I. General information

NPI: 1063790848
Provider Name (Legal Business Name): AMY JEAN HEILMAN L.C.S.W.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 PROVIDENCE RD
TOWSON MD
21286-5503
US

IV. Provider business mailing address

602 PROVIDENCE RD
TOWSON MD
21286-5503
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-7443
  • Fax:
Mailing address:
  • Phone: 410-583-7443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11825
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: