Provider Demographics
NPI:1447645395
Name:MAXWELL, HEATHER (LCSW, LCADC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:GACHKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:741 MOUNT LUCAS RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1911
Mailing Address - Country:US
Mailing Address - Phone:609-613-4833
Mailing Address - Fax:
Practice Address - Street 1:741 MOUNT LUCAS RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1911
Practice Address - Country:US
Practice Address - Phone:609-613-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00266000101YA0400X
NJ44SC055460001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)