Provider Demographics
NPI:1215716899
Name:JENNIFER HEIDLER GARY PSYD LLC
Entity type:Organization
Organization Name:JENNIFER HEIDLER GARY PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HEIDLER-GARY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:443-924-1395
Mailing Address - Street 1:314 MARTINS COVE RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5951
Mailing Address - Country:US
Mailing Address - Phone:443-924-1395
Mailing Address - Fax:
Practice Address - Street 1:41 STATE CIR STE 8
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1904
Practice Address - Country:US
Practice Address - Phone:443-924-1395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty