Provider Demographics
NPI:1821454406
Name:HELLER, JESSICA E (MPS, ATR-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:HELLER
Suffix:
Gender:F
Credentials:MPS, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GROVE ST STE 14
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4053
Mailing Address - Country:US
Mailing Address - Phone:929-266-3718
Mailing Address - Fax:
Practice Address - Street 1:105 GROVE ST STE 14
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4053
Practice Address - Country:US
Practice Address - Phone:929-266-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001899-1221700000X
NJ16LP00015600221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist