Provider Demographics
NPI:1497962443
Name:MCDUFFUS, HEATHER (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MCDUFFUS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 COMMONWEALTH AVE
Mailing Address - Street 2:#610
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5705
Mailing Address - Country:US
Mailing Address - Phone:617-721-0826
Mailing Address - Fax:
Practice Address - Street 1:11 LAWRENCE ST
Practice Address - Street 2:#322
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1431
Practice Address - Country:US
Practice Address - Phone:978-687-1617
Practice Address - Fax:978-687-1597
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2136881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical