Healthcare Provider Details

I. General information

NPI: 1720852718
Provider Name (Legal Business Name): LYNN MARIE HEFFERN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LYNN MARIE VOEGELE

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MAPLE AVE
VOORHEESVILLE NY
12186-9726
US

IV. Provider business mailing address

91 ORCHARD ST
DELMAR NY
12054-1620
US

V. Phone/Fax

Practice location:
  • Phone: 518-765-2382
  • Fax:
Mailing address:
  • Phone: 610-716-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095674
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: