Provider Demographics
NPI:1477792422
Name:STEPHENS, HEATHER L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:STEPHENS
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 1:2414 FRONT ST
Mailing Address - Street 2:#38
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1428
Mailing Address - Country:US
Mailing Address - Phone:619-203-9123
Mailing Address - Fax:
Practice Address - Street 1:4025 CAMINO DEL RIO S
Practice Address - Street 2:#300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4107
Practice Address - Country:US
Practice Address - Phone:619-203-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21470103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist