Healthcare Provider Details

I. General information

NPI: 1801492129
Provider Name (Legal Business Name): KRISTEN HECKEROTH PSYD, CPRP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN GERMAN

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N PRESTON ST
PHILADELPHIA PA
19104-2211
US

IV. Provider business mailing address

3131 MEETINGHOUSE RD APT E4
UPPER CHICHESTER PA
19061-2913
US

V. Phone/Fax

Practice location:
  • Phone: 908-910-3994
  • Fax:
Mailing address:
  • Phone: 908-910-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS020734
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: