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General NPI Number Information
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NPI Number | 1285456590
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Entity Type | Individual
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Provider Name | MICHELLE HEIDAMI
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Gender | Female
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 590 FLATBUSH AVENUE 14 S
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City | BROOKLYN
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State | NY
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Zip | 11225
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Country | US
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Telephone | 917-722-2392
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Fax |
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Provider Business Mailing Address
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Address Line | 900 WEST 190TH STREET 6N
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City | NEW YORK CITY
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State | NY
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Zip | 10040
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Country | US
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Telephone | 281-744-1223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 014299
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License Number State | NY
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