Provider Demographics
NPI:1346329968
Name:CARLBERG, HEATHER DAWNE (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:DAWNE
Last Name:CARLBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 SAN ANSELMO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2614
Mailing Address - Country:US
Mailing Address - Phone:415-342-7939
Mailing Address - Fax:925-513-4376
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-342-7939
Practice Address - Fax:925-513-4376
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2233342084P0800X
CAC548652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ960163Medicaid
NM59677031Medicaid
NM59677031Medicaid
AZI39860Medicare UPIN