Provider Demographics
NPI:1710283403
Name:TAYLOR, HEATHER LYNN
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:TAYLOR
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 1:1371 BEACON ST
Mailing Address - Street 2:SUITE 304-305
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4905
Mailing Address - Country:US
Mailing Address - Phone:207-240-9106
Mailing Address - Fax:
Practice Address - Street 1:1371 BEACON ST
Practice Address - Street 2:SUITE 304-305
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4905
Practice Address - Country:US
Practice Address - Phone:207-240-9106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA10024103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health