Healthcare Provider Details

I. General information

NPI: 1508973876
Provider Name (Legal Business Name): SUSAN HEFFNER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 BELLEVUE AVE SUITE 1
NEWPORT RI
02840-3500
US

IV. Provider business mailing address

226 BELLEVUE AVE SUITE 1
NEWPORT RI
02840-3500
US

V. Phone/Fax

Practice location:
  • Phone: 401-849-5600
  • Fax:
Mailing address:
  • Phone: 401-849-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01641
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: