Provider Demographics
NPI:1407651482
Name:HEATON, GIAVANNA
Entity type:Individual
Prefix:
First Name:GIAVANNA
Middle Name:
Last Name:HEATON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 W BROAD ST APT E
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5733
Mailing Address - Country:US
Mailing Address - Phone:484-935-9530
Mailing Address - Fax:
Practice Address - Street 1:40 S 4TH ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-3802
Practice Address - Country:US
Practice Address - Phone:610-762-8690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAMF000054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist