Provider Demographics
NPI:1881472959
Name:HEGLEMAN, JANE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HEGLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MONTAUK
Mailing Address - State:NY
Mailing Address - Zip Code:11954-5221
Mailing Address - Country:US
Mailing Address - Phone:917-734-4105
Mailing Address - Fax:
Practice Address - Street 1:161 E LAKE DR
Practice Address - Street 2:
Practice Address - City:MONTAUK
Practice Address - State:NY
Practice Address - Zip Code:11954-5221
Practice Address - Country:US
Practice Address - Phone:917-734-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112681104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty