Provider Demographics
NPI:1528014867
Name:HEPPEN-GORDON, CAROL (MSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:HEPPEN-GORDON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2121
Mailing Address - Country:US
Mailing Address - Phone:978-443-7952
Mailing Address - Fax:508-481-2609
Practice Address - Street 1:221 BOSTON POST RD
Practice Address - Street 2:SUITE 450
Practice Address - City:MARLBORO
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:508-460-9633
Practice Address - Fax:508-481-2609
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GO P21955Medicare ID - Type Unspecified