Provider Demographics
NPI:1699781781
Name:HEVERIN, JOHN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:HEVERIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2563 EILEEN RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1308
Mailing Address - Country:US
Mailing Address - Phone:516-599-2290
Mailing Address - Fax:516-599-2815
Practice Address - Street 1:302 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1521
Practice Address - Country:US
Practice Address - Phone:516-599-2290
Practice Address - Fax:516-599-2815
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11793103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV8C601Medicare ID - Type Unspecified