Provider Demographics
NPI:1518023688
Name:BERR, HEIDI NANCY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:NANCY
Last Name:BERR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3809
Mailing Address - Country:US
Mailing Address - Phone:516-764-9896
Mailing Address - Fax:
Practice Address - Street 1:256 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3809
Practice Address - Country:US
Practice Address - Phone:516-764-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041632-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11-3574200OtherEMPLOYER IDENTIFICATION N