Provider Demographics
NPI:1215267224
Name:HEIMAN, MARA (LCSW)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:HEIMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 WEST END AVENUE
Mailing Address - Street 2:SUITE 3Y
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2618
Mailing Address - Country:US
Mailing Address - Phone:212-362-8420
Mailing Address - Fax:
Practice Address - Street 1:285 WEST END AVENUE
Practice Address - Street 2:SUITE 3Y
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2618
Practice Address - Country:US
Practice Address - Phone:212-362-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X, 102L00000X, 103K00000X, 1041C0700X, 106H00000X
NYR033145-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist