Provider Demographics
NPI:1962542357
Name:HEDDERMAN, GRACE DOROTHY (MA, CRC)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:DOROTHY
Last Name:HEDDERMAN
Suffix:
Gender:F
Credentials:MA, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 1ST AVE
Mailing Address - Street 2:#14D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8605
Mailing Address - Country:US
Mailing Address - Phone:212-684-0748
Mailing Address - Fax:212-423-7024
Practice Address - Street 1:485 1ST AVE
Practice Address - Street 2:14D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8605
Practice Address - Country:US
Practice Address - Phone:212-684-0748
Practice Address - Fax:212-423-7024
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health