Provider Demographics
NPI:1265776942
Name:UFBERG, HEATHER J (PSYD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:UFBERG
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 1:1405 SHADY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1350
Mailing Address - Country:US
Mailing Address - Phone:412-420-2253
Mailing Address - Fax:412-420-2510
Practice Address - Street 1:810 CLAIRTON BLVD STE 500600
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-5505
Practice Address - Country:US
Practice Address - Phone:412-650-1100
Practice Address - Fax:412-650-1101
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016555103TR0400X, 103TS0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102782329-0001Medicaid