Provider Demographics
NPI:1881100162
Name:PRIMUS, HEATHER (MA-ABA, BCBA, LBS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:PRIMUS
Suffix:
Gender:
Credentials:MA-ABA, BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 TRENTON AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1814
Mailing Address - Country:US
Mailing Address - Phone:800-394-1106
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 326
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-0326
Practice Address - Country:US
Practice Address - Phone:908-884-9950
Practice Address - Fax:908-634-1690
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-25-80056103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0891886Medicaid