Provider Demographics
NPI:1518190198
Name:HECK, MARY E (LICSW, BCD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:HECK
Suffix:
Gender:F
Credentials:LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PRINCETON DR UNIT 306
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1750
Mailing Address - Country:US
Mailing Address - Phone:717-343-8685
Mailing Address - Fax:
Practice Address - Street 1:90 PRINCETON DR UNIT 306
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1750
Practice Address - Country:US
Practice Address - Phone:717-343-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW1193481041C0700X
PACW0178701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA119348OtherSOCIAL WORK LICENSE
PACW017870OtherLICENSED CLINICAL SOCIAL WORKDER