Provider Demographics
NPI:1104242544
Name:ZAWISLAK, HEATHER (MA, LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ZAWISLAK
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:MCCAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCSW
Mailing Address - Street 1:15 MOTLEY ST
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565
Mailing Address - Country:US
Mailing Address - Phone:516-247-9124
Mailing Address - Fax:
Practice Address - Street 1:15 MOTLEY ST
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565
Practice Address - Country:US
Practice Address - Phone:516-247-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72090103104100000X
NY0849611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker