Individual provider Active NPI

Heather E Lasslett, PHD

  • Clinical Psychologist
  • Mount Airy, MD
National Provider Identifier
1790255404
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
06208 Issued in MD
Practice address
1311 S Main St Ste 202
Mount Airy, MD 21771-5457
Phone
(301) 829-2242
Fax
(301) 829-2290
NPI assigned
Nov 26, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 06208 MD Primary

Addresses

Primary practice location

1311 S Main St Ste 202
Mount Airy, MD 21771-5457

Mailing address

1311 S Main St Ste 202
Mount Airy, MD 21771-5457
Phone (301) 829-2242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220302003022 MD Practitioner - Clinical Psychologist 7810381118 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
06208MDMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of North Carolina, PC CurrentSince Mar 13, 2024 Accepting new patients
Optum Behavioral Care of North Carolina, PC Current Accepting new patients
Optum Behavioral Care of North Carolina, P.C. CurrentSince Mar 13, 2024 Accepting new patients

Locations

1311 S Main St
Ste 202
Mount Airy, MD 21771
Phone (301) 829-2242

650 Ritchie Hwy
Ste 207
Severna Park, MD 21146
Phone (410) 315-9350

1380 Progress Way
Ste 101
Sykesville, MD 21784
Phone (410) 549-5181

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1790255404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 S MAIN ST STE 202",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217715457",
            "telephone_number": "301-829-2242",
            "fax_number": "301-829-2290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 S MAIN ST STE 202",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217715457",
            "telephone_number": "301-829-2242",
            "fax_number": "301-829-2290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASSLETT",
        "first_name": "HEATHER",
        "middle_name": "E",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-26",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "06208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Airy, MD

Sources for this page

Verify at the official NPI Registry.