Healthcare Provider Details

I. General information

NPI: 1629687405
Provider Name (Legal Business Name): MAUREEN THERESE HEISTERKAMP LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 EUCLID AVE STE 100
CLEVELAND OH
44115-2418
US

IV. Provider business mailing address

161 BROOKFIELD RD
AVON LAKE OH
44012-1574
US

V. Phone/Fax

Practice location:
  • Phone: 617-379-0496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2103454
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2303736
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: