Individual
HEATHER LYNNE PROVENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
890 MOUNTAIN AVE, BEHAVIORAL HEALTH & COGNITIVE THERAPY, NEW PROVIDENCE, NJ 07974
(908) 277-8900
(908) 508-8919
Mailing address
1 DIAMOND HILL RD, BERKELEY HEIGHTS, NJ 07922-2104
(908) 273-4300
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26NJ01289400
NJ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
F402394-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05265370
—
NY
Enumeration date
07/09/2018
Last updated
07/03/2023
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