Provider Demographics
NPI:1417209990
Name:HECKENDORN-EVANS, MARIE (BA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:HECKENDORN-EVANS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6021
Mailing Address - Country:US
Mailing Address - Phone:800-686-5614
Mailing Address - Fax:
Practice Address - Street 1:1815 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6021
Practice Address - Country:US
Practice Address - Phone:800-686-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst