Provider Demographics
NPI:1316990732
Name:GANZER, HEIKO (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:HEIKO
Middle Name:
Last Name:GANZER
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NEPTUNE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-9623
Mailing Address - Country:US
Mailing Address - Phone:631-744-3108
Mailing Address - Fax:631-849-6429
Practice Address - Street 1:4 NEPTUNE RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9623
Practice Address - Country:US
Practice Address - Phone:631-744-3108
Practice Address - Fax:631-849-6429
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0557071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY346531OtherMHN
NY7370072OtherAETNA
NY7483430OtherGHI
NY7483430OtherVALUE OPTIONS
NY055707OtherHIP
NYN5J732OtherEMPIRE BC/BS
NY02397822Medicaid
NY0239782204Medicaid
NYP1119530OtherOXFORD
NY1060287EFOtherCIGNA BEHAVORAL HEALTH
NYN5J732OtherEMPIRE BC/BS
NY7483430OtherVALUE OPTIONS