Provider Demographics
NPI:1972679686
Name:HEPPNER, MARJORIE C (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:C
Last Name:HEPPNER
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 1:1130 TEN ROD RD
Mailing Address - Street 2:MEADOWS OFFICE PARK SUITE D205A
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4158
Mailing Address - Country:US
Mailing Address - Phone:401-295-5320
Mailing Address - Fax:401-295-5320
Practice Address - Street 1:1130 TEN ROD RD
Practice Address - Street 2:MEADOWS OFFICE PARK SUITE D205A
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4158
Practice Address - Country:US
Practice Address - Phone:401-295-5320
Practice Address - Fax:401-295-5320
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00378103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI93404OtherBLUE CROSS BLUE SHIELD
RI93404OtherBLUE CROSS BLUE SHIELD