Provider Demographics
NPI:1629113634
Name:ONEILL, HEATHER LEIGH (PSYD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEIGH
Last Name:ONEILL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:TOWNSEND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:50 ROSECRANS ST BLDG 500
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-4408
Mailing Address - Country:US
Mailing Address - Phone:619-553-0246
Mailing Address - Fax:
Practice Address - Street 1:50 ROSECRANS ST BLDG 500
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-4408
Practice Address - Country:US
Practice Address - Phone:619-553-0426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN20042402A103TC0700X
CAPSY30720103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN768046500Medicaid