Provider Demographics
NPI:1023374816
Name:LOFFREDO, HEATHER ROSE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ROSE
Last Name:LOFFREDO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11161 NEW HAMPSHIRE AVE
Mailing Address - Street 2:STE 307
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2606
Mailing Address - Country:US
Mailing Address - Phone:301-593-6554
Mailing Address - Fax:
Practice Address - Street 1:11161 NEW HAMPSHIRE AVE
Practice Address - Street 2:STE 307
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2606
Practice Address - Country:US
Practice Address - Phone:301-593-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04889103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent