Provider Demographics
NPI:1184084915
Name:PLEICKHARDT, HEATHER (PHD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:PLEICKHARDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 NEWLAKE DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5472
Mailing Address - Country:US
Mailing Address - Phone:516-473-8009
Mailing Address - Fax:
Practice Address - Street 1:112 NEWLAKE DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5472
Practice Address - Country:US
Practice Address - Phone:516-473-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021352103TC0700X
FLPY9693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical