Healthcare Provider Details

I. General information

NPI: 1467503813
Provider Name (Legal Business Name): LYNDA HEIDEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 EL MONTE AVE SUITE B
MOUNTAIN VIEW CA
94040-2320
US

IV. Provider business mailing address

122 GREENMEADOW WAY
PALO ALTO CA
94306-4517
US

V. Phone/Fax

Practice location:
  • Phone: 650-856-0338
  • Fax:
Mailing address:
  • Phone: 650-856-0338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY14455
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY14455
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY14455
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY14455
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY14455
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY14455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: