Provider Demographics
NPI:1366002602
Name:MARRIATORI, HEATHER (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:MARRIATORI
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13005 IRVING AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2255
Mailing Address - Country:US
Mailing Address - Phone:619-540-1184
Mailing Address - Fax:
Practice Address - Street 1:4420 HOTEL CIRCLE CT STE 350
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3435
Practice Address - Country:US
Practice Address - Phone:619-540-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6938103TC0700X
CA31034103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical