Provider Demographics
NPI:1891783486
Name:LOGAN, HEIDI FALK (LICSW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:FALK
Last Name:LOGAN
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 1:24 PARK ST # 1
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3314
Mailing Address - Country:US
Mailing Address - Phone:781-572-2840
Mailing Address - Fax:781-938-1106
Practice Address - Street 1:10 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6364
Practice Address - Country:US
Practice Address - Phone:781-860-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-08
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1067911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05590Medicare ID - Type UnspecifiedLICSW