Provider Demographics
NPI:1407923865
Name:KIEBLER-BROGAN, HEIDI C (LPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:C
Last Name:KIEBLER-BROGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 NORTH AVE WEST
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016
Mailing Address - Country:US
Mailing Address - Phone:908-456-1871
Mailing Address - Fax:
Practice Address - Street 1:34 DUMONT RD
Practice Address - Street 2:
Practice Address - City:FAR HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07931
Practice Address - Country:US
Practice Address - Phone:908-456-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00083500101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health