Provider Demographics
NPI:1225101066
Name:HELLER, PAULA J (LCSW, BCD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:HELLER
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GLEN HILL LN
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5055
Mailing Address - Country:US
Mailing Address - Phone:914-332-1223
Mailing Address - Fax:914-332-1224
Practice Address - Street 1:239 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2674
Practice Address - Country:US
Practice Address - Phone:914-582-7595
Practice Address - Fax:914-332-1224
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO26377-31041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02013409Medicaid
NYN58111Medicare ID - Type Unspecified