MEDICARE: MARA HEIMAN L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	102L00000X	Psychoanalyst
4	103K00000X	Behavior Analyst
5	1041C0700X	Clinical Social Worker
6	1041C0700X	Clinical Social Worker	R033145-1	NY
7	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1215267224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARA HEIMAN L.C.S.W.

Provider Business Mailing Address
First Line	:	285 WEST END AVENUE
Second Line	:	SUITE 3Y
City	:	NEW YORK
State	:	NY
Zip	:	10023-2618
Country	:	US
Telephone Number	:	212-362-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 WEST END AVENUE
Second Line	:	SUITE 3Y
City	:	NEW YORK
State	:	NY
Zip	:	10023-2618
Country	:	US
Telephone Number	:	212-362-8420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	01/14/2010

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Directions to “ MARA HEIMAN L.C.S.W.” Practice Location

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