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General NPI Number Information
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NPI Number | 1356881429
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Entity Type | Organization
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Legal Business Name | HOLLY HESTON, LLC
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 530 PROSPECT AVE
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1444
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Country | US
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Telephone | 732-337-4038
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Fax |
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Provider Business Mailing Address
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Address Line | 19 LEXINGTON CT
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City | RED BANK
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State | NJ
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Zip | 07701-5456
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Country | US
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Telephone | 732-337-4038
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORK
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Name | MISS HOLLY A HESTON
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Credential | LCSW
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Telephone | 732-337-4038
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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 | 44SC05722300
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License Number State | NJ
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