MEDICARE: DR. LYNDA HEIDEN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY14455	CA
2	103TB0200X	Cognitive & Behavioral Psychologist	PSY14455	CA
3	103TC0700X	Clinical Psychologist	PSY14455	CA
4	103TC2200X	Clinical Child & Adolescent Psychologist	PSY14455	CA
5	103TH0100X	Health Service Psychologist	PSY14455	CA
6	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PSY14455	CA

General Provider Information

NPI Number	:	1467503813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNDA HEIDEN PH.D.

Provider Business Mailing Address
First Line	:	122 GREENMEADOW WAY
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94306-4517
Country	:	US
Telephone Number	:	650-856-0338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1059 EL MONTE AVE
Second Line	:	SUITE B
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2320
Country	:	US
Telephone Number	:	650-856-0338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2007
Last Update Date	:	09/11/2025

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