Provider Demographics
NPI:1518061266
Name:HAMELBERG, HEIDE (PHD)
Entity Type:Individual
Prefix:MRS
First Name:HEIDE
Middle Name:
Last Name:HAMELBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 LAGUNA DR APT 42
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1848
Mailing Address - Country:US
Mailing Address - Phone:310-487-7640
Mailing Address - Fax:
Practice Address - Street 1:2945 HARDING ST STE 103
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1818
Practice Address - Country:US
Practice Address - Phone:310-487-7640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15284103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist