Provider Demographics
NPI:1508936865
Name:HECK, KELLY A (LICSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:HECK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:SHUFF-HECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:166 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-2419
Mailing Address - Country:US
Mailing Address - Phone:413-358-5697
Mailing Address - Fax:
Practice Address - Street 1:10 WENDELL AVENUE EXT
Practice Address - Street 2:STE 201
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6283
Practice Address - Country:US
Practice Address - Phone:413-358-5697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1132611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA33305OtherHEALTH NEW ENGLAND