Provider Demographics
NPI:1750499216
Name:HEIL, WILLIAM BRADFORD (PHD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRADFORD
Last Name:HEIL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 POTRERO STREET
Mailing Address - Street 2:SUITE 55
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-423-8106
Mailing Address - Fax:831-423-6106
Practice Address - Street 1:303 POTRERO STREET
Practice Address - Street 2:SUITE 55
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-423-8106
Practice Address - Fax:831-423-6106
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP5416528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P20760Medicare UPIN