Provider Information for 1033706841
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HEATHER CUSTODIO LCSW
Other Names:Former Name:Ms. HEATHER WATSONSex: Female
NPI: 1033706841
Last Updated: 2021-12-09
Certification Date: 2021-12-09
Certification Date: 2021-12-09
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1033706841 | ||||||||||||||
| Enumeration Date | 2020-12-28 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 13462 MONTSERRAT CT CHINO HILLS, CA 91709-1327 United States Phone: 626-823-7140 | Fax: | ||||||||||||||
| Primary Practice Address | 13462 MONTSERRAT CT CHINO HILLS, CA 91709-1327 United States Phone: 626-823-7140 | Fax: | ||||||||||||||
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