Provider Demographics
NPI:1376034140
Name:COMPASSIONATE GROWTH COUNSELING
Entity Type:Organization
Organization Name:COMPASSIONATE GROWTH COUNSELING
Other - Org Name:HEATHER RUEMENAPP LICSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:CHENEY
Authorized Official - Last Name:RUEMENAPP
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:339-545-1368
Mailing Address - Street 1:57 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3510
Mailing Address - Country:US
Mailing Address - Phone:781-572-8644
Mailing Address - Fax:
Practice Address - Street 1:22 MILL ST STE 207
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4738
Practice Address - Country:US
Practice Address - Phone:339-545-1368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1112261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700027554OtherNPI
MA1700027554Medicaid