Healthcare Provider Details

I. General information

NPI: 1033443379
Provider Name (Legal Business Name): AMBER HEILER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMBER GARDNER LCSW

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 10/21/2020
Certification Date: 10/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 BAINBRIDGE ST
PHILADELPHIA PA
19147-1810
US

IV. Provider business mailing address

1348 BAINBRIDGE ST
PHILADELPHIA PA
19147-1810
US

V. Phone/Fax

Practice location:
  • Phone: 215-563-0652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW019105
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: