Provider Demographics
NPI:1679836316
Name:HEAVEY, TERESITA DWYER (MS ED)
Entity Type:Individual
Prefix:MS
First Name:TERESITA
Middle Name:DWYER
Last Name:HEAVEY
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 E 20TH ST
Mailing Address - Street 2:8H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-1509
Mailing Address - Country:US
Mailing Address - Phone:917-696-5349
Mailing Address - Fax:
Practice Address - Street 1:626 E 20TH ST
Practice Address - Street 2:8H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-1509
Practice Address - Country:US
Practice Address - Phone:917-696-5349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1093863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist