MEDICARE: DR. MICHAEL RICHARD HEANEY PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	008199	NY

General Provider Information

NPI Number	:	1346275518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RICHARD HEANEY PSY.D.

Provider Business Mailing Address
First Line	:	372 FULLERTON AVE
Second Line	:	STE 3
City	:	NEWBURGH
State	:	NY
Zip	:	12550-3744
Country	:	US
Telephone Number	:	845-565-2167
Fax Number	:

Provider Business Practice Location Address
First Line	:	372 FULLERTON AVE
Second Line	:	STE 3
City	:	NEWBURGH
State	:	NY
Zip	:	12550-3744
Country	:	US
Telephone Number	:	845-565-2167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	11/30/2016

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