Healthcare Provider Details

I. General information

NPI: 1770575995
Provider Name (Legal Business Name): BRIGITTE HEFFERNAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 MAIN ST
NEWTON NJ
07860-2056
US

IV. Provider business mailing address

93 MAIN ST
NEWTON NJ
07860-2056
US

V. Phone/Fax

Practice location:
  • Phone: 908-200-9308
  • Fax: 908-854-0985
Mailing address:
  • Phone: 908-200-9308
  • Fax: 908-854-0985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04838500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: