Provider Demographics
NPI:1982289740
Name:MARK HEYMAN PSYCHOLOGIST INC
Entity Type:Organization
Organization Name:MARK HEYMAN PSYCHOLOGIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-461-9295
Mailing Address - Street 1:4374 CHELFORD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4130
Mailing Address - Country:US
Mailing Address - Phone:858-461-9295
Mailing Address - Fax:858-751-7582
Practice Address - Street 1:12526 HIGH BLUFF DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2067
Practice Address - Country:US
Practice Address - Phone:858-461-9295
Practice Address - Fax:858-751-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty