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NPI Code Detail

MEDICARE: MRS. KATHERINE HEFFERNAN PSYCHOLOGY ASSISTANT

MEDICARE: MRS. KATHERINE HEFFERNAN PSYCHOLOGY ASSISTANT
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
1103TC2200XClinical Child & Adolescent Psychologist

General Provider Information

NPI Number : 1871766931
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHERINE HEFFERNAN PSYCHOLOGY ASSISTANT
Provider Business Mailing Address
First Line : 2250 PLEASANT AVE
Second Line :
City : HAMILTON
State : OH
Zip : 45015-1135
Country : US
Telephone Number : 513-868-1562
Fax Number : 513-868-1415
Provider Business Practice Location Address
First Line : 2250 PLEASANT AVE
Second Line :
City : HAMILTON
State : OH
Zip : 45015-1135
Country : US
Telephone Number : 513-868-1562
Fax Number : 513-558-3880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2008
Last Update Date : 03/30/2018

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