Provider Demographics
NPI:1730675125
Name:NEVULIS, HEATHER (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:NEVULIS
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 EARLY RED CIR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1792
Mailing Address - Country:US
Mailing Address - Phone:508-224-7432
Mailing Address - Fax:
Practice Address - Street 1:78 EARLY RED CIR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-1792
Practice Address - Country:US
Practice Address - Phone:508-224-7432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10318021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1031802OtherCOMMONWEALTH OF MASSACHUSETTS BOARD OF SOCIAL WORKERS