Provider Demographics
NPI:1184287435
Name:UNFOLD PSYCHOLOGY: A. HEAFEY PRACTICE
Entity type:Organization
Organization Name:UNFOLD PSYCHOLOGY: A. HEAFEY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:HEAFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-615-0711
Mailing Address - Street 1:1955 MOUNTAIN BLVD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611
Mailing Address - Country:US
Mailing Address - Phone:202-615-0711
Mailing Address - Fax:
Practice Address - Street 1:1955 MOUNTAIN BLVD.
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611
Practice Address - Country:US
Practice Address - Phone:202-615-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNFOLD PSYCHOLOGY A HEAFEY PRACTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-22
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty