Provider Demographics
NPI:1568225415
Name:HEIMAN, BRANDON FITZGERALD (BEHAVIORAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:FITZGERALD
Last Name:HEIMAN
Suffix:
Gender:M
Credentials:BEHAVIORAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 GORHAM AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4738
Mailing Address - Country:US
Mailing Address - Phone:310-622-5147
Mailing Address - Fax:
Practice Address - Street 1:1080 S LA CIENEGA BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2680
Practice Address - Country:US
Practice Address - Phone:661-213-9340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician