Provider Demographics
NPI:1962652123
Name:HEINBACH, KAREN (BA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HEINBACH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W CRYSTAL LAKE AVE
Mailing Address - Street 2:APT. 134A
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-3100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 W CRYSTAL LAKE AVE
Practice Address - Street 2:APT. 134A
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-3100
Practice Address - Country:US
Practice Address - Phone:856-541-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health