Provider Demographics
NPI:1861804007
Name:PLATT, HEIDI (CAADE-I 4014-R)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:PLATT
Suffix:
Gender:F
Credentials:CAADE-I 4014-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 931
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019
Mailing Address - Country:US
Mailing Address - Phone:707-813-0440
Mailing Address - Fax:
Practice Address - Street 1:826 MAHLER ROAD
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010
Practice Address - Country:US
Practice Address - Phone:650-689-5597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4014-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)