Provider Demographics
NPI:1871827378
Name:HEFFERNAN, DECEMBER L (LCSW)
Entity Type:Individual
Prefix:
First Name:DECEMBER
Middle Name:L
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 STATE ST STE 200
Mailing Address - Street 2:P.O. BOX 2170
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6304
Mailing Address - Country:US
Mailing Address - Phone:860-443-0036
Mailing Address - Fax:860-439-6423
Practice Address - Street 1:165 STATE ST STE 200
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6304
Practice Address - Country:US
Practice Address - Phone:860-443-0036
Practice Address - Fax:860-439-6423
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0070121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical