Active NPI
Maya Heffernan, MA
- Marriage & Family Therapist
- San Diego, CA
National Provider Identifier
1780920652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 111639
- Practice address
- 3990 Old Town Ave Ste B100
San Diego, CA 92110-2967 - Phone
- (619) 277-1930
- NPI assigned
- Dec 21, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 111639 | CA | Primary |
Addresses
Primary practice location
3990 Old Town Ave Ste B100
San Diego, CA 92110-2967
Mailing address
3990 Old Town Ave Ste B100
San Diego, CA 92110-2967
Phone (619) 277-1930
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 31, 2024 through Jan 31, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111639 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1356048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644969600000",
"number": "1780920652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3990 OLD TOWN AVE STE B100",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921102967",
"telephone_number": "619-277-1930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3990 OLD TOWN AVE STE B100",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921102967",
"telephone_number": "619-277-1930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEFFERNAN",
"first_name": "MAYA",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-21",
"last_updated": "2022-02-16",
"certification_date": "2022-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "111639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.