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General NPI Number Information
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NPI Number | 1366002602
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Entity Type | Individual
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Provider Name | HEATHER MARRIATORI PHD, LP
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 4420 HOTEL CIRCLE CT STE 350
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City | SAN DIEGO
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State | CA
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Zip | 92108-3435
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Country | US
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Telephone | 619-540-1184
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Fax |
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Provider Business Mailing Address
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Address Line | 13005 IRVING AVE S
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City | BURNSVILLE
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State | MN
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Zip | 55337-2255
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Country | US
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Telephone | 619-540-1184
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP6938
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31034
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License Number State | CA
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