Provider Demographics
NPI:1528304508
Name:LOPEZ, HEATHER L (PSYD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:IEPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 LOG CANOE CIR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2127
Mailing Address - Country:US
Mailing Address - Phone:410-604-0226
Mailing Address - Fax:
Practice Address - Street 1:155 LOG CANOE CIR
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2127
Practice Address - Country:US
Practice Address - Phone:410-604-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05314103TC0700X
DEB1-0001028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
4607871OtherCIGNA
V338-0008OtherCAREFIRST BLUECROSS BLUESHIELD
600810391OtherMAGELLAN MIS
MD0685631 00Medicaid