Provider Demographics
NPI:1396704300
Name:KIPPING-REGITANO, HEATHER ANN (LCSW-R)
Entity type:Individual
Prefix:PROF
First Name:HEATHER
Middle Name:ANN
Last Name:KIPPING-REGITANO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:PROF
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:HARFOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4284 FRASER FIR DR
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-8339
Mailing Address - Country:US
Mailing Address - Phone:315-491-4445
Mailing Address - Fax:315-682-6016
Practice Address - Street 1:4284 FRASER FIR DR
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-8339
Practice Address - Country:US
Practice Address - Phone:315-491-4445
Practice Address - Fax:315-682-6016
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR056766-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical