=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891116612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACHIEVE YOUR FULL POTENTIAL, LCSW, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2013
-----------------------------------------------------
Last Update Date | 12/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 E 50TH ST SUITE 108C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-7504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-285-4343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 E 50TH ST SUITE 108C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-7504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-285-4343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATHERINE HEEG
-----------------------------------------------------
Credential | MSW, LCSW-R
-----------------------------------------------------
Telephone | 646-285-4343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R079147
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------