Provider Demographics
NPI:1417927245
Name:HELLER, PEGGY OSNA (MSW PHD)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:OSNA
Last Name:HELLER
Suffix:
Gender:F
Credentials:MSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 WHITERIM TER
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1775
Mailing Address - Country:US
Mailing Address - Phone:301-983-3392
Mailing Address - Fax:
Practice Address - Street 1:7715 WHITERIM TER
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1775
Practice Address - Country:US
Practice Address - Phone:301-983-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05043104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q837PO27OtherBLUE SHIELD
Q837PO27OtherBLUE SHIELD