Provider Demographics
NPI:1326073099
Name:HEISDORF, ROBERT (MSW, LCSW, LMFT, BCD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HEISDORF
Suffix:
Gender:M
Credentials:MSW, LCSW, LMFT, BCD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:HEISDORF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW, LMFT, BCD
Mailing Address - Street 1:PO BOX 27698
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-7698
Mailing Address - Country:US
Mailing Address - Phone:559-261-9999
Mailing Address - Fax:559-433-3472
Practice Address - Street 1:7341 N 1ST ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2948
Practice Address - Country:US
Practice Address - Phone:559-261-9999
Practice Address - Fax:559-433-3472
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS35221041C0700X
CAMFC5364106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ76663ZMedicare ID - Type UnspecifiedMEDICARE