Healthcare Provider Details

I. General information

NPI: 1437967692
Provider Name (Legal Business Name): CORINNA JO HEINDEL LSW, LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINNA WOLDT MSW, APSW

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S BURROWES ST STE 604
STATE COLLEGE PA
16801-3864
US

IV. Provider business mailing address

700 MASSACHUSETTS AVE FL 3
CAMBRIDGE MA
02139-3345
US

V. Phone/Fax

Practice location:
  • Phone: 888-500-2067
  • Fax: 617-649-8520
Mailing address:
  • Phone: 888-500-2067
  • Fax: 617-649-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150115381
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13070-123
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2140959
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1144885
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW142266
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: