Provider Demographics
NPI:1184758914
Name:HESCHELES, KIMBERLY (PSYD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:HESCHELES
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 1:4250 VETERANS HWY
Mailing Address - Street 2:STE 215
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4035
Mailing Address - Country:US
Mailing Address - Phone:631-981-5762
Mailing Address - Fax:631-981-5762
Practice Address - Street 1:4250 VETERANS HWY
Practice Address - Street 2:STE 215
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4035
Practice Address - Country:US
Practice Address - Phone:631-981-5762
Practice Address - Fax:631-981-5762
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012547103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01625167Medicaid
NYV14831Medicare PIN