Provider Demographics
NPI:1760938880
Name:HEIMARK, MATTHEW C (MS)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:C
Last Name:HEIMARK
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 SACRAMENTO ST
Mailing Address - Street 2:227
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1914
Mailing Address - Country:US
Mailing Address - Phone:415-314-3253
Mailing Address - Fax:
Practice Address - Street 1:250 EXECUTIVE PARK BLVD
Practice Address - Street 2:4900
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-3394
Practice Address - Country:US
Practice Address - Phone:415-314-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMB94123101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health