Provider Demographics
NPI:1447689989
Name:NELSON, HEATHER LINDSEY HOWE (MA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LINDSEY HOWE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LINDSEY
Other - Last Name:HOWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2728 DURANT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1725
Mailing Address - Country:US
Mailing Address - Phone:510-841-9230
Mailing Address - Fax:
Practice Address - Street 1:345 SPEAR ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1673
Practice Address - Country:US
Practice Address - Phone:415-291-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA29030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program