Healthcare Provider Details

I. General information

NPI: 1164662375
Provider Name (Legal Business Name): JOHN H. HECKLER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 MAIN ST SUITE 5
TEWKSBURY MA
01876-4723
US

IV. Provider business mailing address

1445 MAIN ST SUITE 5
TEWKSBURY MA
01876-4723
US

V. Phone/Fax

Practice location:
  • Phone: 978-851-4251
  • Fax: 978-851-8515
Mailing address:
  • Phone: 978-851-4251
  • Fax: 978-851-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2483
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6616
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1000
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number2483
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1000
License Number StateNH
# 6
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number2483
License Number StateMA
# 7
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1000
License Number StateNH
# 8
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1000
License Number StateNH
# 9
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6616
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2483
License Number StateMA
# 11
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1000
License Number StateNH
# 12
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6616
License Number StateCA
# 13
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2483
License Number StateMA
# 14
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1000
License Number StateNH
# 15
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2483
License Number StateMA

VIII. Authorized Official

Name: DR. JOHN H. HECKLER
Title or Position: OWNER
Credential: PHD
Phone: 978-851-4251