Provider Demographics
NPI:1609019231
Name:GIRVAN, HEATHER R (LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:GIRVAN
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 1:463 15TH ST
Mailing Address - Street 2:FLOOR 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5703
Mailing Address - Country:US
Mailing Address - Phone:347-526-0368
Mailing Address - Fax:
Practice Address - Street 1:1309-1311 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-282-0010
Practice Address - Fax:718-693-4490
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071504-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical