=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518989169
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN LERNER HECKLES LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 709 E GAY ST
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19380-4567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-544-2110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 PENNWOOD DR
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19543-8905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-544-2110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW014427
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------