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General NPI Number Information
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NPI Number | 1770664344
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Entity Type | Individual
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Provider Name | THOMAS J VANDEN HEUVEL LCSW, CEAP, SAC, SAP
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 12012 W NORTH AVE
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City | WAUWATOSA
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State | WI
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Zip | 53226-2040
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Country | US
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Telephone | 262-224-6468
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Fax |
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Provider Business Mailing Address
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Address Line | 2063 SAINT PATRICK CIR
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City | HARTFORD
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State | WI
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Zip | 53027-9776
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Country | US
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Telephone | 262-224-6468
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Fax | 262-787-7909
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7058-123
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License Number State | WI
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