Provider Demographics
NPI:1275181034
Name:BERNADETTE B. HEID, PSY.D., LLC
Entity Type:Organization
Organization Name:BERNADETTE B. HEID, PSY.D., LLC
Other - Org Name:BERNADETTE B. HEID, PSY.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HEID
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:858-585-0812
Mailing Address - Street 1:PO BOX 3076
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-6076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 305
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3933
Practice Address - Country:US
Practice Address - Phone:858-585-0812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty