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General NPI Number Information
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NPI Number | 1972694032
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Entity Type | Individual
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Provider Name | MARY BETH HELLER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 5931 HARBOUR PARK DR
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2163
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Country | US
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Telephone | 804-693-1136
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Fax | 804-639-5584
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Provider Business Mailing Address
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Address Line | 5931 HARBOUR PARK DR
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2163
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Country | US
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Telephone | 804-693-1136
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Fax | 804-639-5584
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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 | 0810003684
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License Number State | VA
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