Provider Demographics
NPI:1932233137
Name:HELLER, CHARLENE KROLL (LAC)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:KROLL
Last Name:HELLER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BABBITT RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-1836
Mailing Address - Country:US
Mailing Address - Phone:914-263-1988
Mailing Address - Fax:
Practice Address - Street 1:51 BABBITT RD
Practice Address - Street 2:SUITE 8
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-1836
Practice Address - Country:US
Practice Address - Phone:914-263-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000970-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist