Healthcare Provider Details

I. General information

NPI: 1700202314
Provider Name (Legal Business Name): JENNIFER HEFFERNAN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS DR STE 201
MORGANVILLE NJ
07751-1253
US

IV. Provider business mailing address

320 SOUTH ST APT 18J
MORRISTOWN NJ
07960-6067
US

V. Phone/Fax

Practice location:
  • Phone: 732-786-5585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05874600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: