Provider Demographics
NPI:1457772287
Name:M.A.HEILMAN,PHD., LLC
Entity Type:Organization
Organization Name:M.A.HEILMAN,PHD., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-841-3884
Mailing Address - Street 1:4949 MCCLEARY JACOBY ROAD
Mailing Address - Street 2:MAHEILMAN,PHD., LLC
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410
Mailing Address - Country:US
Mailing Address - Phone:330-841-3884
Mailing Address - Fax:330-841-3514
Practice Address - Street 1:8747 SQUIRES LANE NE
Practice Address - Street 2:HILLSIDE REHABILITATION HOSPITAL
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484
Practice Address - Country:US
Practice Address - Phone:330-841-3884
Practice Address - Fax:330-841-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5061283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2083516Medicaid
OHCP18241Medicare PIN