Provider Demographics
NPI:1386879674
Name:AXMAN, HEATHER (LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:AXMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05363-0051
Mailing Address - Country:US
Mailing Address - Phone:954-554-2368
Mailing Address - Fax:802-923-3912
Practice Address - Street 1:5 MOUNTAIN PARK PLAZA
Practice Address - Street 2:
Practice Address - City:WEST DOVER
Practice Address - State:VT
Practice Address - Zip Code:05356-9999
Practice Address - Country:US
Practice Address - Phone:802-464-8105
Practice Address - Fax:802-923-3912
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0125990101YA0400X
FLMCAP.0100249101YA0400X
FLSW94371041C0700X
NY0794681041C0700X
VT089.00828321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCV824AMedicare PIN