Provider Demographics
NPI:1215024054
Name:HELLER, PHIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHIL
Middle Name:
Last Name:HELLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 NW CORPORATE BLVD
Mailing Address - Street 2:110
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7387
Mailing Address - Country:US
Mailing Address - Phone:561-994-4565
Mailing Address - Fax:561-994-3552
Practice Address - Street 1:2200 NW CORPORATE BLVD
Practice Address - Street 2:110
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7387
Practice Address - Country:US
Practice Address - Phone:561-994-4565
Practice Address - Fax:561-994-3552
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3822103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical