Healthcare Provider Details

I. General information

NPI: 1023988268
Provider Name (Legal Business Name): HEBA R KHALIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 SHERWOOD PL APT B3
STRATFORD CT
06615-6539
US

IV. Provider business mailing address

490 SHERWOOD PL APT B3
STRATFORD CT
06615-6539
US

V. Phone/Fax

Practice location:
  • Phone: 203-828-8901
  • Fax:
Mailing address:
  • Phone: 203-828-8901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7493
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: