Provider Demographics
NPI:1255396958
Name:DOUGLASS, HEIDI (PHD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:NORTH DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764-0253
Mailing Address - Country:US
Mailing Address - Phone:508-672-0005
Mailing Address - Fax:206-666-4822
Practice Address - Street 1:1610 GAR HWY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-1210
Practice Address - Country:US
Practice Address - Phone:508-672-0005
Practice Address - Fax:206-666-4822
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00858103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29246-7OtherBLUE CROSS BLUE SHIELD RI