Provider Demographics
NPI:1760563837
Name:DALZELL, HEIDI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:DALZELL
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 1:192 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08530-1626
Mailing Address - Country:US
Mailing Address - Phone:215-630-7154
Mailing Address - Fax:215-752-1983
Practice Address - Street 1:241 W. MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2131
Practice Address - Country:US
Practice Address - Phone:215-630-7154
Practice Address - Fax:215-752-1983
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016112103TC0700X
NJ35S100430300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical