Provider Demographics
NPI:1861501868
Name:TOLL, HEATHER J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:J
Last Name:TOLL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SCOVILL ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1127
Mailing Address - Country:US
Mailing Address - Phone:203-573-9521
Mailing Address - Fax:203-573-8708
Practice Address - Street 1:133 SCOVILL ST
Practice Address - Street 2:SUITE 211
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1127
Practice Address - Country:US
Practice Address - Phone:203-573-9521
Practice Address - Fax:203-573-8708
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002519103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060002519CT01OtherBLUE SHIELD