Provider Demographics
NPI:1710462809
Name:CROSSEN, HEATHER MARIE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:CROSSEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BROADWAY APT 1
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4432
Mailing Address - Country:US
Mailing Address - Phone:978-239-1616
Mailing Address - Fax:
Practice Address - Street 1:27 BROADWAY APT 1
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4432
Practice Address - Country:US
Practice Address - Phone:978-239-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10244291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical