Provider Demographics
NPI:1053332551
Name:HERON, SUZANN P
Entity Type:Individual
Prefix:MS
First Name:SUZANN
Middle Name:P
Last Name:HERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SUMNER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-9529
Mailing Address - Country:US
Mailing Address - Phone:413-374-1433
Mailing Address - Fax:
Practice Address - Street 1:131 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-1150
Practice Address - Country:US
Practice Address - Phone:413-374-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4597101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health