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General NPI Number Information
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NPI Number | 1457551731
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Entity Type | Individual
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Provider Name | LIZA JANE HECK
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Gender | Female
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 1627 WAVERLY ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1508
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Country | US
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Telephone | 215-732-9442
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Fax |
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Provider Business Mailing Address
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Address Line | 1627 WAVERLY ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1508
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Country | US
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Telephone | 215-732-9442
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS007216L
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License Number State | PA
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