Provider Demographics
NPI:1699827238
Name:HECKELMAN, LEORA (PHD)
Entity Type:Individual
Prefix:
First Name:LEORA
Middle Name:
Last Name:HECKELMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W 58TH ST STE 607
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1818
Mailing Address - Country:US
Mailing Address - Phone:212-586-5268
Mailing Address - Fax:
Practice Address - Street 1:330 W 58TH ST STE 607
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1818
Practice Address - Country:US
Practice Address - Phone:212-586-5268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0168111103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV8C151Medicare ID - Type Unspecified