Provider Demographics
NPI:1104171339
Name:HEIDEL, KRISTI NICOLE (LSW)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:NICOLE
Last Name:HEIDEL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 LYDIA ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15207-1182
Mailing Address - Country:US
Mailing Address - Phone:814-599-8702
Mailing Address - Fax:
Practice Address - Street 1:4233 LYDIA ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15207-1182
Practice Address - Country:US
Practice Address - Phone:814-599-8702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129672104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker