Provider Demographics
NPI:1235288838
Name:HEYWOOD, FELICIA M (LICSW)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:M
Last Name:HEYWOOD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5465
Mailing Address - Country:US
Mailing Address - Phone:781-891-0556
Mailing Address - Fax:781-647-1432
Practice Address - Street 1:118 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5465
Practice Address - Country:US
Practice Address - Phone:781-891-0556
Practice Address - Fax:781-647-1432
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2135951041C0700X
MA1176611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical