Provider Demographics
NPI:1164203105
Name:DINNEEN, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DINNEEN
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:PO BOX 1042
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-6042
Mailing Address - Country:US
Mailing Address - Phone:860-671-9315
Mailing Address - Fax:
Practice Address - Street 1:1180 ASHLEY FALLS RD STE A
Practice Address - Street 2:
Practice Address - City:ASHLEY FALLS
Practice Address - State:MA
Practice Address - Zip Code:01222-9705
Practice Address - Country:US
Practice Address - Phone:860-671-9315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1270581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical