Provider Demographics
NPI:1528687134
Name:CONOLLY, HEATHER LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:CONOLLY
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 1:1061 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-4113
Mailing Address - Country:US
Mailing Address - Phone:443-480-3171
Mailing Address - Fax:
Practice Address - Street 1:650 RANCOCAS RD
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-5613
Practice Address - Country:US
Practice Address - Phone:609-518-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056699001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical