Provider Demographics
NPI:1568706398
Name:HELLER, KERRY (MSED)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HARVEST HILL RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-3509
Mailing Address - Country:US
Mailing Address - Phone:203-232-6499
Mailing Address - Fax:
Practice Address - Street 1:825 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5349
Practice Address - Country:US
Practice Address - Phone:212-851-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1117079174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist