Provider Demographics
NPI:1871766931
Name:HEFFERNAN, KATHERINE (PSYCHOLOGY ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:PSYCHOLOGY ASSISTANT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:LACKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2250 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1135
Mailing Address - Country:US
Mailing Address - Phone:513-868-1562
Mailing Address - Fax:513-868-1415
Practice Address - Street 1:2250 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015-1135
Practice Address - Country:US
Practice Address - Phone:513-868-1562
Practice Address - Fax:513-558-3880
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent