Provider Demographics
NPI:1821101528
Name:HELLER, ROBERT M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:HELLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:URI
Other - Middle Name:
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:758 N LARRABEE ST
Mailing Address - Street 2:APT 801
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6452
Mailing Address - Country:US
Mailing Address - Phone:312-988-7792
Mailing Address - Fax:312-988-4040
Practice Address - Street 1:1 E SUPERIOR ST
Practice Address - Street 2:310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2507
Practice Address - Country:US
Practice Address - Phone:312-988-7792
Practice Address - Fax:312-988-4040
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1003286103TS0200X
IL071-002999103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2011001Medicare PIN