Provider Demographics
NPI:1245050954
Name:HEETER, PAIGE ELIZABETH
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:HEETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 85TH ST APT 32
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2121
Mailing Address - Country:US
Mailing Address - Phone:717-813-2930
Mailing Address - Fax:
Practice Address - Street 1:155 E 85TH ST APT 32
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2121
Practice Address - Country:US
Practice Address - Phone:717-813-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health