Healthcare Provider Details

I. General information

NPI: 1821101528
Provider Name (Legal Business Name): ROBERT M HELLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: URI HELLER PH.D.

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E SUPERIOR ST 310
CHICAGO IL
60611-2507
US

IV. Provider business mailing address

758 N LARRABEE ST APT 801
CHICAGO IL
60654-6452
US

V. Phone/Fax

Practice location:
  • Phone: 312-988-7792
  • Fax: 312-988-4040
Mailing address:
  • Phone: 312-339-9452
  • Fax: 312-988-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1003286
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-002999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: