Provider Demographics
NPI:1407912892
Name:LILIENTHAL, HEIDI T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:T
Last Name:LILIENTHAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:T
Other - Last Name:LILIENTHAL-BLASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:26 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2018
Mailing Address - Country:US
Mailing Address - Phone:978-239-4651
Mailing Address - Fax:
Practice Address - Street 1:55 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2628
Practice Address - Country:US
Practice Address - Phone:978-239-4651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7685103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical