Provider Demographics
NPI:1447279690
Name:MACLEOD, HEATHER ANN (EDD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANN
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAURENCE HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2823
Mailing Address - Country:US
Mailing Address - Phone:908-688-5215
Mailing Address - Fax:
Practice Address - Street 1:106 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:LAURENCE HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08879-2823
Practice Address - Country:US
Practice Address - Phone:908-688-5215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3561103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0005094661OtherAETNA HEALTH CARE
NJ7479905Medicaid
NJ22-3571543OtherCORPORATION ID