Provider Demographics
NPI:1699080200
Name:HEPWORTH, TINA (MSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:HEPWORTH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N NAPPANEE ST STE 4A
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1502
Mailing Address - Country:US
Mailing Address - Phone:574-522-8992
Mailing Address - Fax:574-246-0171
Practice Address - Street 1:500 N NAPPANEE ST STE 4A
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1502
Practice Address - Country:US
Practice Address - Phone:574-522-8992
Practice Address - Fax:574-246-0171
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical