Healthcare Provider Details

I. General information

NPI: 1952509994
Provider Name (Legal Business Name): MARY CLAIRE HEFFRON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST EARLY CHILDHOOD MENTAL HEALTH
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND ST EARLY CHILDHOOD MENTAL HEALTH
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3407
  • Fax: 510-238-9764
Mailing address:
  • Phone: 510-428-3407
  • Fax: 510-238-9764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number16058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: