Provider Demographics
NPI:1164244307
Name:HELLER, GABRIEL PAUL (LP)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:PAUL
Last Name:HELLER
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 COURT ST STE 2011
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-1120
Mailing Address - Country:US
Mailing Address - Phone:347-320-9717
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 2011
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1120
Practice Address - Country:US
Practice Address - Phone:347-320-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001160-01103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis