Provider Demographics
NPI:1457558967
Name:HELLER, LENORE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LENORE
Middle Name:
Last Name:HELLER
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 1:12550 LAKE AVE
Mailing Address - Street 2:SUITE 1501
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1575
Mailing Address - Country:US
Mailing Address - Phone:216-870-0807
Mailing Address - Fax:216-712-7709
Practice Address - Street 1:12550 LAKE AVE
Practice Address - Street 2:SUITE 1501
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-1575
Practice Address - Country:US
Practice Address - Phone:216-870-0807
Practice Address - Fax:216-712-7709
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6571103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP34481OtherPALMETTO GBA