Provider Demographics
NPI:1033882337
Name:DERUITER, HEIDI SUE (LP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:SUE
Last Name:DERUITER
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 E 7TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-5930
Mailing Address - Country:US
Mailing Address - Phone:917-841-6419
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE RM 1106
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8017
Practice Address - Country:US
Practice Address - Phone:917-841-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001102102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst