Provider Demographics
NPI:1417362815
Name:HECKMAN, LORRAINE (MAPC, BSL)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:HECKMAN
Suffix:
Gender:F
Credentials:MAPC, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORT CARBON
Mailing Address - State:PA
Mailing Address - Zip Code:17965-1329
Mailing Address - Country:US
Mailing Address - Phone:570-515-4297
Mailing Address - Fax:
Practice Address - Street 1:211 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORT CARBON
Practice Address - State:PA
Practice Address - Zip Code:17965-1329
Practice Address - Country:US
Practice Address - Phone:570-516-4297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001750103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst