Provider Demographics
NPI:1952017923
Name:KMETZ, HEATHER ERIN (BSL)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ERIN
Last Name:KMETZ
Suffix:
Gender:F
Credentials:BSL
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ERIN
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 CHAMPAGNE AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1348
Mailing Address - Country:US
Mailing Address - Phone:814-243-0715
Mailing Address - Fax:
Practice Address - Street 1:103 CHAMPAGNE AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1348
Practice Address - Country:US
Practice Address - Phone:814-243-0715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PABH005945103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health