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General NPI Number Information
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NPI Number | 1831764539
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Entity Type | Individual
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Provider Name | HEATHER PEDERSEN LSW
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Gender | Female
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 50 WILSON DR
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City | SPARTA
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State | NJ
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Zip | 07871-3400
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Country | US
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Telephone | 973-534-0690
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Fax |
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Provider Business Mailing Address
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Address Line | 114 PORT DR
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City | DINGMANS FRY
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State | PA
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Zip | 18328-4370
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Country | US
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Telephone | 973-534-0690
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00370800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW024272
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC06143800
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License Number State | NJ
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