Provider Demographics
NPI:1225691652
Name:GERSON, HEIDI (LMFT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:GERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W GRANADA BLVD STE G3
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9407
Mailing Address - Country:US
Mailing Address - Phone:386-330-3308
Mailing Address - Fax:
Practice Address - Street 1:555 W GRANADA BLVD STE G3
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9407
Practice Address - Country:US
Practice Address - Phone:386-320-3308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT5246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health