Provider Demographics
NPI:1184876575
Name:HEAVENS, BRIAN JEREMY
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JEREMY
Last Name:HEAVENS
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:ONE MEDICAL CENTER BOULEVARD
Mailing Address - Street 2:CROZER CHESTER MEDICAL CENTER
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013-2098
Mailing Address - Country:US
Mailing Address - Phone:610-447-7600
Mailing Address - Fax:610-447-7606
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-447-7600
Practice Address - Fax:610-447-7606
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health