Active NPI
Thomas Edward Heinzen
- Clinical Psychologist
- Valley Cottage, NY
National Provider Identifier
1073559951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 68 012043
- Practice address
- 476 Christian Herald Rd
Valley Cottage, NY 10989-2230 - Phone
- (845) 268-6861
- NPI assigned
- Jun 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 68 012043 | NY | Primary |
Addresses
Primary practice location
476 Christian Herald Rd
Valley Cottage, NY 10989-2230
Mailing address
905 Bloomfield Ave
Glen Ridge, NJ 07028-1329
Phone (973) 748-0622
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01592781 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 68 012043 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1073559951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "905 BLOOMFIELD AVE",
"city": "GLEN RIDGE",
"state": "NJ",
"postal_code": "070281329",
"telephone_number": "973-748-0622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "476 CHRISTIAN HERALD RD",
"city": "VALLEY COTTAGE",
"state": "NY",
"postal_code": "109892230",
"telephone_number": "845-268-6861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEINZEN",
"first_name": "THOMAS",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-21",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "68 012043",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01592781",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valley Cottage, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.