Provider Demographics
NPI:1184251670
Name:BERNADETTE B. HEID, PSY.D., A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity type:Organization
Organization Name:BERNADETTE B. HEID, PSY.D., A PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEID
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:858-585-0812
Mailing Address - Street 1:PO BOX 3076
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-6076
Mailing Address - Country:US
Mailing Address - Phone:858-585-0812
Mailing Address - Fax:858-259-3502
Practice Address - Street 1:12625 HIGH BLUFF DR STE 111
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2053
Practice Address - Country:US
Practice Address - Phone:858-585-0812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty