Provider Demographics
NPI:1396968467
Name:DIDOMENICO, HEATHER IRENE (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:IRENE
Last Name:DIDOMENICO
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 US HIGHWAY 206 STE 1
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9238
Mailing Address - Country:US
Mailing Address - Phone:973-668-4806
Mailing Address - Fax:862-205-6072
Practice Address - Street 1:185 US HIGHWAY 206 STE 1
Practice Address - Street 2:
Practice Address - City:ROXBURY TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07836-9238
Practice Address - Country:US
Practice Address - Phone:973-668-4806
Practice Address - Fax:862-205-6072
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00317200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7545842OtherAETNA OUT NETWORK ID