Provider Demographics
NPI:1679867246
Name:NORTHUP, HEATHER LAURIE
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LAURIE
Last Name:NORTHUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 S ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02724-1504
Mailing Address - Country:US
Mailing Address - Phone:774-644-4806
Mailing Address - Fax:
Practice Address - Street 1:2348 POST RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2258
Practice Address - Country:US
Practice Address - Phone:401-681-4637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor