Healthcare Provider Details

I. General information

NPI: 1992811251
Provider Name (Legal Business Name): ROBIN NICOLE HEFFERNAN MS, LMFT, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 SPRINGFIELD DR SUITE 140
BLOOMINGDALE IL
60108-2214
US

IV. Provider business mailing address

290 SPRINGFIELD DR SUITE 140
BLOOMINGDALE IL
60108-2214
US

V. Phone/Fax

Practice location:
  • Phone: 630-561-5849
  • Fax:
Mailing address:
  • Phone: 630-561-5849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166000630
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180006319
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: