Provider Demographics
NPI:1003323221
Name:KATHLYN HECKART LLC
Entity Type:Organization
Organization Name:KATHLYN HECKART LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKART
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-324-9194
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-0500
Mailing Address - Country:US
Mailing Address - Phone:401-324-9194
Mailing Address - Fax:
Practice Address - Street 1:38 BELLEVUE AVE STE J
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3260
Practice Address - Country:US
Practice Address - Phone:401-324-9194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW02100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health