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General NPI Number Information
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NPI Number | 1215061866
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Entity Type | Individual
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Provider Name | HEIDI SHYDO LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 25 CENTRAL PARK W SUITE 1U
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City | NEW YORK
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State | NY
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Zip | 10023-7253
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Country | US
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Telephone | 347-732-1005
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Fax |
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Provider Business Mailing Address
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Address Line | 6024 CREEKSTONE LN
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City | CENTREVILLE
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State | VA
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Zip | 20120-3407
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Country | US
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Telephone | 631-495-5474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904016795
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 076680
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License Number State | NY
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