Individual
HEATHER CHARBONEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, MED
Contact information
Practice address
3535 MARKET ST, PHILADELPHIA, PA 19104-3309
(610) 892-3800
Mailing address
3535 MARKET ST, PHILADELPHIA, PA 19104-3309
(610) 892-3800
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW019700
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CW019700
PA
PA
Enumeration date
05/16/2023
Last updated
05/16/2023
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