Provider Demographics
NPI:1326342106
Name:JONAS, HEATHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:JONAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 FOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-1023
Mailing Address - Country:US
Mailing Address - Phone:631-834-3624
Mailing Address - Fax:
Practice Address - Street 1:445 BROADHOLLOW RD
Practice Address - Street 2:SUITE 25
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3669
Practice Address - Country:US
Practice Address - Phone:631-834-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68017697103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist