Provider Demographics
NPI:1619090172
Name:PERRYMAN, HEIDI P (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:P
Last Name:PERRYMAN
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 1:3704 MT DIABLO BLVD
Mailing Address - Street 2:SUITE 319
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3684
Mailing Address - Country:US
Mailing Address - Phone:925-283-4499
Mailing Address - Fax:925-283-4412
Practice Address - Street 1:3704 MT DIABLO BLVD
Practice Address - Street 2:SUITE 319
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3684
Practice Address - Country:US
Practice Address - Phone:925-283-4499
Practice Address - Fax:925-283-4412
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13775103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent