Provider Demographics
NPI:1649394321
Name:LANDIS, HEIDI BETH (RDT, LCAT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:BETH
Last Name:LANDIS
Suffix:
Gender:F
Credentials:RDT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 W 89TH ST
Mailing Address - Street 2:#6P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1959
Mailing Address - Country:US
Mailing Address - Phone:646-295-1027
Mailing Address - Fax:
Practice Address - Street 1:189 W 89TH ST
Practice Address - Street 2:#6P
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1959
Practice Address - Country:US
Practice Address - Phone:646-295-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000917221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist