Provider Demographics
NPI:1982751160
Name:HELLER, CHARLES HARRIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HARRIS
Last Name:HELLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ELYISE RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1413
Mailing Address - Country:US
Mailing Address - Phone:845-354-0535
Mailing Address - Fax:845-354-1287
Practice Address - Street 1:9 ELYISE RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1413
Practice Address - Country:US
Practice Address - Phone:845-354-0535
Practice Address - Fax:845-354-1287
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006642-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY051377OtherVALUE OPTIONS
NYP368525OtherOXFORD
MN62046OtherUNITED BEHAVIORAL HEALTH