Provider Demographics
NPI:1003137985
Name:ELLIOTT, HEATHER (LMHC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4598
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NORTH QUABBIN RETREAT
Practice Address - Street 2:211 NORTH MAIN STREET
Practice Address - City:PETERSHAM
Practice Address - State:MA
Practice Address - Zip Code:01366
Practice Address - Country:US
Practice Address - Phone:978-724-0010
Practice Address - Fax:978-724-0011
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300881Medicaid