Provider Demographics
NPI:1467430348
Name:HEINZ, BRAD ROBERT (PH D)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:ROBERT
Last Name:HEINZ
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1556 LAMONT NORWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-7194
Mailing Address - Country:US
Mailing Address - Phone:919-929-8379
Mailing Address - Fax:
Practice Address - Street 1:1556 LAMONT NORWOOD RD
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-7194
Practice Address - Country:US
Practice Address - Phone:919-929-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1478103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000777Medicaid
NC0358AOtherBLUE CROSS BLUE SHIELD OF NORTH CAROLINA
NC2814689EMedicare PIN