Healthcare Provider Details

I. General information

NPI: 1588294904
Provider Name (Legal Business Name): HEATHER WASHBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2483 ARTHUR KILL RD
STATEN ISLAND NY
10309-1207
US

IV. Provider business mailing address

2483 ARTHUR KILL RD
STATEN ISLAND NY
10309-1207
US

V. Phone/Fax

Practice location:
  • Phone: 718-559-0431
  • Fax:
Mailing address:
  • Phone: 718-559-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number017030-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: