Provider Demographics
NPI:1790255404
Name:LASSLETT, HEATHER E (PHD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:E
Last Name:LASSLETT
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 1:1311 S MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5457
Mailing Address - Country:US
Mailing Address - Phone:301-829-2242
Mailing Address - Fax:301-829-2290
Practice Address - Street 1:1311 S MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5457
Practice Address - Country:US
Practice Address - Phone:301-829-2242
Practice Address - Fax:301-829-2290
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05208OtherLICENSE