Healthcare Provider Details

I. General information

NPI: 1255996435
Provider Name (Legal Business Name): FREDERICK HEUSER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 E EVESHAM RD STE 200A
VOORHEES NJ
08043-1437
US

IV. Provider business mailing address

PO BOX 7776
LANCASTER PA
17604-7776
US

V. Phone/Fax

Practice location:
  • Phone: 856-355-7118
  • Fax: 856-325-5222
Mailing address:
  • Phone: 888-985-2727
  • Fax: 856-779-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020244
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05860700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: