MEDICARE: MAUREEN THERESE HEISTERKAMP LPCC

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	101Y00000X	Counselor	C.2103454	OH
2	101YP2500X	Professional Counselor	E.2303736	OH

General Provider Information

NPI Number	:	1629687405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN THERESE HEISTERKAMP LPCC

Provider Business Mailing Address
First Line	:	161 BROOKFIELD RD
Second Line	:
City	:	AVON LAKE
State	:	OH
Zip	:	44012-1574
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 EUCLID AVE STE 100
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2418
Country	:	US
Telephone Number	:	617-379-0496
Fax Number	:

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

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	12/18/2025

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