Provider Demographics
NPI:1386895787
Name:CARUSO-MAXEY, HEATHER BELLE (PHD)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:BELLE
Last Name:CARUSO-MAXEY
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 89
Mailing Address - Street 2:
Mailing Address - City:SUNOL
Mailing Address - State:CA
Mailing Address - Zip Code:94586-0089
Mailing Address - Country:US
Mailing Address - Phone:510-754-2471
Mailing Address - Fax:
Practice Address - Street 1:39465 PASEO PADRE PKWY STE 2100
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1624
Practice Address - Country:US
Practice Address - Phone:510-745-9151
Practice Address - Fax:510-745-9152
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26830103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical