Healthcare Provider Details

I. General information

NPI: 1497886923
Provider Name (Legal Business Name): LORI ANN VARGO HEFFNER MA., EDM., LCADC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WESCOTT DR HBH
FLEMINGTON NJ
08822-4603
US

IV. Provider business mailing address

2100 WESCOTT DR HBH 5TH FL ATTN LILY
FLEMINGTON NJ
08822-4603
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6401
  • Fax: 908-788-6584
Mailing address:
  • Phone: 908-788-6401
  • Fax: 908-788-6584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00115800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: