MEDICARE: CARLA HAYLEY HEYWARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1063975035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA HAYLEY HEYWARD

Provider Business Mailing Address
First Line	:	7 MARCUS GARVEY BLVD STE 420
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-5303
Country	:	US
Telephone Number	:	917-966-5255
Fax Number	:	917-966-5254

Provider Business Practice Location Address
First Line	:	7 MARCUS GARVEY BLVD STE 420
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-5303
Country	:	US
Telephone Number	:	917-966-5255
Fax Number	:	917-966-5254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2019
Last Update Date	:	06/11/2019

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