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General NPI Number Information
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NPI Number | 1790255404
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Entity Type | Individual
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Provider Name | HEATHER E LASSLETT PHD
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Gender | Female
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 1311 S MAIN ST STE 202
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City | MOUNT AIRY
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State | MD
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Zip | 21771-5457
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Country | US
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Telephone | 301-829-2242
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Fax | 301-829-2290
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Provider Business Mailing Address
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Address Line | 1311 S MAIN ST STE 202
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City | MOUNT AIRY
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State | MD
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Zip | 21771-5457
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Country | US
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Telephone | 301-829-2242
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Fax | 301-829-2290
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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 | 06208
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License Number State | MD
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