Provider Demographics
NPI:1427273556
Name:VAN HORNE, HEIDI KOLLER (PSYD,)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:KOLLER
Last Name:VAN HORNE
Suffix:
Gender:F
Credentials:PSYD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 KNICKERBOCKER AVE
Mailing Address - Street 2:APT. 2R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-5355
Mailing Address - Country:US
Mailing Address - Phone:718-715-5992
Mailing Address - Fax:646-775-6602
Practice Address - Street 1:24 UNION SQ E
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3201
Practice Address - Country:US
Practice Address - Phone:646-775-6626
Practice Address - Fax:646-775-6602
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016923103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily