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General NPI Number Information
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NPI Number | 1396968467
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Entity Type | Individual
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Provider Name | HEATHER IRENE DIDOMENICO MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 185 US HIGHWAY 206 STE 1
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City | ROXBURY TOWNSHIP
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State | NJ
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Zip | 07836-9238
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Country | US
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Telephone | 973-668-4806
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Fax | 862-205-6072
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Provider Business Mailing Address
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Address Line | 185 US HIGHWAY 206 STE 1
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City | FLANDERS
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State | NJ
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Zip | 07836-9238
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Country | US
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Telephone | 973-668-4806
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Fax | 862-205-6072
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37PC00317200
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License Number State | NJ
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