| Heather J Dale Licensed Clinical Social Worker Corporation | |
|
13300 Garden Grove Blvd Garden Grove CA 92843-2207 | |
| (949) 278-2204 | |
| Not Available |
| Full Name | Heather J Dale Licensed Clinical Social Worker Corporation |
|---|---|
| Speciality | Social Worker |
| Location | 13300 Garden Grove Blvd, Garden Grove, California |
| Authorized Official Name and Position | Heather J Dale (PRESIDENT) |
| Authorized Official Contact | 9492782204 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heather J Dale Licensed Clinical Social Worker Corporation 3500 Rosehedge Dr Fullerton CA 92835-1628 Ph: (949) 278-2204 | Heather J Dale Licensed Clinical Social Worker Corporation 13300 Garden Grove Blvd Garden Grove CA 92843-2207 Ph: (949) 278-2204 |
| NPI Number | 1528534427 |
|---|---|
| Provider Enumeration Date | 10/17/2018 |
| Last Update Date | 01/17/2019 |
| Medicare PECOS PAC ID | 8123364197 |
|---|---|
| Medicare Enrollment ID | O20190111001472 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528534427 | NPI | - | NPPES |
| 1891137733 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Heather J Dale |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891137733 PECOS PAC ID: 0840536827 Enrollment ID: I20190214000596 |
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