=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821599622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUDITH E. HEFREN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2018
-----------------------------------------------------
Last Update Date | 03/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1906 SE 14TH AVE
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-5464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-445-0260
-----------------------------------------------------
Fax | 877-377-1386
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1906 SE 14TH AVE
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-5464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-445-0260
-----------------------------------------------------
Fax | 877-377-1386
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JUDITH E HEFREN
-----------------------------------------------------
Credential | PHD, MSW
-----------------------------------------------------
Telephone | 850-445-0260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW3257
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------