MEDICARE: DR. MARJORIE C HEPPNER PHD

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	PS00378	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	93404	OTHER	RI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1972679686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARJORIE C HEPPNER PHD

Provider Business Mailing Address
First Line	:	1130 TEN ROD RD
Second Line	:	MEADOWS OFFICE PARK SUITE D205A
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4158
Country	:	US
Telephone Number	:	401-295-5320
Fax Number	:	401-295-5320

Provider Business Practice Location Address
First Line	:	1130 TEN ROD RD
Second Line	:	MEADOWS OFFICE PARK SUITE D205A
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4158
Country	:	US
Telephone Number	:	401-295-5320
Fax Number	:	401-295-5320

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	08/04/2010

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