Healthcare Provider Details

I. General information

NPI: 1467430348
Provider Name (Legal Business Name): BRAD ROBERT HEINZ PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1556 LAMONT NORWOOD RD
PITTSBORO NC
27312-7194
US

IV. Provider business mailing address

1556 LAMONT NORWOOD RD
PITTSBORO NC
27312-7194
US

V. Phone/Fax

Practice location:
  • Phone: 919-929-8379
  • Fax:
Mailing address:
  • Phone: 919-929-8379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1478
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: