Provider Demographics
NPI:1801953450
Name:HEARTLAND PSYCHOLOGICAL SERVICES PC
Entity type:Organization
Organization Name:HEARTLAND PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SEEY
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOONE MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-494-9397
Mailing Address - Street 1:PO BOX 141280
Mailing Address - Street 2:HEARTLAND PSYCHOLOGICAL SERVICES PC
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1280
Mailing Address - Country:US
Mailing Address - Phone:718-494-9397
Mailing Address - Fax:718-761-1000
Practice Address - Street 1:251 RICHMOND HILL RD
Practice Address - Street 2:HEARTLAND PSYCHOLOGICAL SERVICES P.C.
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5906
Practice Address - Country:US
Practice Address - Phone:718-494-9397
Practice Address - Fax:718-761-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty