Active NPI
Mary Beth Heller, PH.D.
- Clinical Psychologist
- Midlothian, VA
National Provider Identifier
1972694032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810003684
- Practice address
- 5931 Harbour Park Dr
Midlothian, VA 23112-2163 - Phone
- (804) 693-1136
- Fax
- (804) 639-5584
- NPI assigned
- Sep 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810003684 | VA | Primary |
Addresses
Primary practice location
5931 Harbour Park Dr
Midlothian, VA 23112-2163
Mailing address
5931 Harbour Park Dr
Midlothian, VA 23112-2163
Phone (804) 693-1136
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 237695 | Other | VA | ANTHEM PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 8, 2024 through Nov 8, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810003684 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1972694032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5931 HARBOUR PARK DR",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "231122163",
"telephone_number": "804-693-1136",
"fax_number": "804-639-5584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5931 HARBOUR PARK DR",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "231122163",
"telephone_number": "804-693-1136",
"fax_number": "804-639-5584"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HELLER",
"first_name": "MARY",
"middle_name": "BETH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-27",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810003684",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NUMBER",
"identifier": "237695",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Midlothian, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.