Provider Demographics
NPI:1710136122
Name:GOLDBERG, HEATHER JEAN (PSYD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JEAN
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:JEAN
Other - Last Name:STERK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:110 TRADERS CROSS
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-4637
Mailing Address - Country:US
Mailing Address - Phone:843-441-6735
Mailing Address - Fax:
Practice Address - Street 1:110 TRADERS CROSS
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-4637
Practice Address - Country:US
Practice Address - Phone:843-441-6735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1635103T00000X
NY019754103T00000X
GAPSY004398103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist