Provider Demographics
NPI:1093365462
Name:HEBROCK, MARIA ROBERT
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ROBERT
Last Name:HEBROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71338 HIGHWAY 21 STE 101
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7162
Mailing Address - Country:US
Mailing Address - Phone:985-624-2942
Mailing Address - Fax:
Practice Address - Street 1:71338 LA-21
Practice Address - Street 2:SUITE 101
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-624-2942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist