Provider Demographics
NPI:1093079071
Name:PESCE, HEATHER L (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:PESCE
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2357
Mailing Address - Country:US
Mailing Address - Phone:631-220-1410
Mailing Address - Fax:
Practice Address - Street 1:158 10TH AVE
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-2357
Practice Address - Country:US
Practice Address - Phone:631-220-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist