Provider Demographics
NPI:1497172662
Name:MAURIN, HEATHER ALYSSA
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ALYSSA
Last Name:MAURIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 APPLETON CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-3647
Mailing Address - Country:US
Mailing Address - Phone:209-670-4141
Mailing Address - Fax:
Practice Address - Street 1:3614 APPLETON CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-3647
Practice Address - Country:US
Practice Address - Phone:209-670-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst