MEDICARE: MRS. HEIDE HAMELBERG PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY15284	CA

General Provider Information

NPI Number	:	1518061266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEIDE HAMELBERG PHD

Provider Business Mailing Address
First Line	:	935 LAGUNA DR APT 42
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1848
Country	:	US
Telephone Number	:	310-487-7640
Fax Number	:

Provider Business Practice Location Address
First Line	:	2945 HARDING ST STE 103
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1818
Country	:	US
Telephone Number	:	310-487-7640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	06/03/2022

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