Provider Demographics
NPI:1750656567
Name:HEFFERON, MATTHEW WILLIAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:HEFFERON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 W BUCKINGHAM PL
Mailing Address - Street 2:1W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2383
Mailing Address - Country:US
Mailing Address - Phone:312-669-4874
Mailing Address - Fax:
Practice Address - Street 1:1650 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3945
Practice Address - Country:US
Practice Address - Phone:847-754-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008309103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical