Provider Demographics
NPI:1659911535
Name:HEERTEN-RODRIGUEZ, LIAM RUSSELL (PHD, MSW, PLMPH)
Entity Type:Individual
Prefix:DR
First Name:LIAM
Middle Name:RUSSELL
Last Name:HEERTEN-RODRIGUEZ
Suffix:
Gender:M
Credentials:PHD, MSW, PLMPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 CHICAGO ST APT 1
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-3020
Mailing Address - Country:US
Mailing Address - Phone:402-419-9777
Mailing Address - Fax:
Practice Address - Street 1:7701 PACIFIC ST STE 323
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-5480
Practice Address - Country:US
Practice Address - Phone:402-242-4720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7428104100000X
NE120651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker