Provider Demographics
NPI:1992811251
Name:HEFFERNAN, ROBIN NICOLE (MS, LMFT, LCPC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:NICOLE
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:MS, LMFT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 SPRINGFIELD DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2214
Mailing Address - Country:US
Mailing Address - Phone:630-561-5849
Mailing Address - Fax:
Practice Address - Street 1:290 SPRINGFIELD DR
Practice Address - Street 2:SUITE 140
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2214
Practice Address - Country:US
Practice Address - Phone:630-561-5849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000630106H00000X
IL180006319101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor