Provider Demographics
NPI:1154631372
Name:KIDNEY, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:KIDNEY
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 1:69 OLD TUCK BOG ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02770
Mailing Address - Country:US
Mailing Address - Phone:508-776-8856
Mailing Address - Fax:
Practice Address - Street 1:69 OLD TUCK BOG ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02770
Practice Address - Country:US
Practice Address - Phone:508-776-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst