Provider Demographics
NPI:1629336003
Name:HEAFEY, RICHARD AUSTIN
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:AUSTIN
Last Name:HEAFEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 RITCH ST
Mailing Address - Street 2:UNIT 302
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1782
Mailing Address - Country:US
Mailing Address - Phone:202-615-0711
Mailing Address - Fax:
Practice Address - Street 1:13666 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2538
Practice Address - Country:US
Practice Address - Phone:202-615-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health