MEDICARE: MISS HEATHER T. CASSELLS-SIMPSON

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	101YS0200X	School Counselor	R0364671	NY
2	1041C0700X	Clinical Social Worker	R0364671	NY

General Provider Information

NPI Number	:	1922306208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HEATHER T. CASSELLS-SIMPSON

Provider Business Mailing Address
First Line	:	11 CHESTNUT ST
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07018-3053
Country	:	US
Telephone Number	:	973-674-0092
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 CHESTNUT ST
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07018-3053
Country	:	US
Telephone Number	:	973-674-0092
Fax Number	:

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

Provider Enumeration Date	:	03/10/2011
Last Update Date	:	03/10/2011

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Directions to “ MISS HEATHER T. CASSELLS-SIMPSON ” Practice Location

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