MEDICARE: DR. HEATHER MARTARELLA PSY.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	103TC0700X	Clinical Psychologist	PSY21758	CA

General Provider Information

NPI Number	:	1861678658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER MARTARELLA PSY.D.

Provider Business Mailing Address
First Line	:	3184 OLD TUNNEL RD
Second Line	:	SUITE G
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3184 OLD TUNNEL RD
Second Line	:	SUITE G
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4153
Country	:	US
Telephone Number	:	510-584-7397
Fax Number	:

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

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/20/2022

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