Provider Demographics
NPI:1669595617
Name:HECKLER, JOHN H (PHD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:H
Last Name:HECKLER
Suffix:
Gender:M
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:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876
Mailing Address - Country:US
Mailing Address - Phone:978-851-4251
Mailing Address - Fax:978-851-8515
Practice Address - Street 1:1445 MAIN STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876
Practice Address - Country:US
Practice Address - Phone:978-851-4251
Practice Address - Fax:978-851-8515
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2483103TC0700X
NH1000103TC0700X
CA6616103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10192Medicare ID - Type Unspecified