Provider Demographics
NPI:1770818817
Name:HYATT, HEATHER W (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:W
Last Name:HYATT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M WHEELOCK
Other - Last Name:HYATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:180 VERRILL RD
Mailing Address - Street 2:
Mailing Address - City:POWNAL
Mailing Address - State:ME
Mailing Address - Zip Code:04069-6321
Mailing Address - Country:US
Mailing Address - Phone:207-740-6216
Mailing Address - Fax:
Practice Address - Street 1:23 DURHAM RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6795
Practice Address - Country:US
Practice Address - Phone:207-869-4022
Practice Address - Fax:207-869-4077
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC101081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical