Provider Demographics
NPI:1164662375
Name:JOHN H. HECKLER, P.C.
Entity Type:Organization
Organization Name:JOHN H. HECKLER, P.C.
Other - Org Name:TEWKSBURY MENTAL HEALTH ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:978-851-4251
Mailing Address - Street 1:1445 MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-4723
Mailing Address - Country:US
Mailing Address - Phone:978-851-4251
Mailing Address - Fax:978-851-8515
Practice Address - Street 1:1445 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-4723
Practice Address - Country:US
Practice Address - Phone:978-851-4251
Practice Address - Fax:978-851-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2483103T00000X, 103TA0400X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X
CA6616103T00000X, 103TC0700X, 103TC1900X
NH1000103T00000X, 103TA0400X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10192OtherBLUE CROSS BLUE SHIELD