Provider Demographics
NPI:1043475924
Name:HEINSSEN, ROBERT KENNETH (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENNETH
Last Name:HEINSSEN
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:P.O. BOX 263
Mailing Address - Street 2:11405 ROKEBY AVE.
Mailing Address - City:GARRETT PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20896-9999
Mailing Address - Country:US
Mailing Address - Phone:240-606-5792
Mailing Address - Fax:
Practice Address - Street 1:11405 ROKEBY AVE.
Practice Address - Street 2:
Practice Address - City:GARRETT PARK
Practice Address - State:MD
Practice Address - Zip Code:20896-9999
Practice Address - Country:US
Practice Address - Phone:240-606-5792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02402103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical