Provider Demographics
NPI:1871873752
Name:DEWEY, HEATHER RENEE (LCSW-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:DEWEY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8003 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4984
Mailing Address - Country:US
Mailing Address - Phone:443-602-5893
Mailing Address - Fax:410-282-1788
Practice Address - Street 1:8003 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4984
Practice Address - Country:US
Practice Address - Phone:443-602-5893
Practice Address - Fax:410-282-1788
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD298521700Medicaid