Healthcare Provider Details

I. General information

NPI: 1851418370
Provider Name (Legal Business Name): CHARLES W HEFFNER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
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 TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW00936
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: