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NPI Code Detail

MEDICARE: HEATHER J DALE LICENSED CLINICAL SOCIAL WORKER CORPORATION

MEDICARE: HEATHER J DALE LICENSED CLINICAL SOCIAL WORKER CORPORATION
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
11041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528534427
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEATHER J DALE LICENSED CLINICAL SOCIAL WORKER CORPORATION
Provider Business Mailing Address
First Line : 3500 ROSEHEDGE DR
Second Line :
City : FULLERTON
State : CA
Zip : 92835-1628
Country : US
Telephone Number : 949-278-2204
Fax Number :
Provider Business Practice Location Address
First Line : 13300 GARDEN GROVE BLVD
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92843-2207
Country : US
Telephone Number : 949-278-2204
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : HEATHER J DALE
Credential : LCSW
Telephone Number : 949-278-2204
Provider Enumeration Date : 10/17/2018
Last Update Date : 01/17/2019

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