Provider Demographics
NPI:1487734851
Name:HEGGENSTALLER, LUCY CAROLE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:LUCY
Middle Name:CAROLE
Last Name:HEGGENSTALLER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 E WINTER RD
Mailing Address - Street 2:
Mailing Address - City:LOGANTON
Mailing Address - State:PA
Mailing Address - Zip Code:17747-9341
Mailing Address - Country:US
Mailing Address - Phone:570-295-9469
Mailing Address - Fax:570-725-2327
Practice Address - Street 1:2367 E WINTER RD
Practice Address - Street 2:
Practice Address - City:LOGANTON
Practice Address - State:PA
Practice Address - Zip Code:17747
Practice Address - Country:US
Practice Address - Phone:570-295-9469
Practice Address - Fax:570-725-2327
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW013497101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1487734851OtherHIGHMARK BLUE SHIELD
PA02096301OtherCAPITAL BLUE CROSS
PA7517339Medicaid
PAS14000Medicare UPIN
PA7517339Medicaid