Provider Demographics
NPI:1487953477
Name:BOHN, HEATHER NICOLE (PHD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:BOHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:ALPERIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2246
Mailing Address - Country:US
Mailing Address - Phone:201-417-9400
Mailing Address - Fax:
Practice Address - Street 1:43 SENECA RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2246
Practice Address - Country:US
Practice Address - Phone:201-417-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018526103T00000X
390200000X
CT4055103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program