Provider Demographics
NPI:1184617508
Name:HECK, CAROL F (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:F
Last Name:HECK
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 1:31877 PASEO LINDO
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-4903
Mailing Address - Country:US
Mailing Address - Phone:760-945-1957
Mailing Address - Fax:760-723-7872
Practice Address - Street 1:31877 PASEO LINDO
Practice Address - Street 2:
Practice Address - City:BONSALL
Practice Address - State:CA
Practice Address - Zip Code:92003-4903
Practice Address - Country:US
Practice Address - Phone:760-723-4159
Practice Address - Fax:760-645-6494
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN198661163W00000X
CAPSY12340103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY123400Medicaid
CAPSY123400Medicaid
R15845Medicare UPIN