Provider Demographics
NPI:1891553426
Name:HEFTER, ZACKARY THOMAS
Entity Type:Individual
Prefix:MR
First Name:ZACKARY
Middle Name:THOMAS
Last Name:HEFTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11119 EASECREST DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3508
Mailing Address - Country:US
Mailing Address - Phone:301-580-7367
Mailing Address - Fax:
Practice Address - Street 1:11119 EASECREST DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3508
Practice Address - Country:US
Practice Address - Phone:301-580-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician