Provider Demographics
NPI:1063760619
Name:O'DONNELL, HEIDI (MSW LCSW)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:M
Other - Last Name:VILSACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 ROUTE 46 W
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1744
Mailing Address - Country:US
Mailing Address - Phone:201-874-2220
Mailing Address - Fax:
Practice Address - Street 1:355 ROUTE 46 W
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1744
Practice Address - Country:US
Practice Address - Phone:201-874-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055764001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical