Provider Demographics
NPI:1184731002
Name:PHILLIPS, HEATHER L (PSYD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3897 ADLER PL
Mailing Address - Street 2:SUITE 130, BLDG C
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9425
Mailing Address - Country:US
Mailing Address - Phone:484-895-3720
Mailing Address - Fax:484-895-3723
Practice Address - Street 1:3897 ADLER PL
Practice Address - Street 2:SUITE 130, BLDG C
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9425
Practice Address - Country:US
Practice Address - Phone:484-895-3720
Practice Address - Fax:484-895-3723
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016356103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical