Provider Demographics
NPI:1922710961
Name:NURICK, HEIDI MICHELLE
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:MICHELLE
Last Name:NURICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:MICHELLE
Other - Last Name:KOPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1099 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1259
Mailing Address - Country:US
Mailing Address - Phone:617-870-9820
Mailing Address - Fax:
Practice Address - Street 1:1099 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1259
Practice Address - Country:US
Practice Address - Phone:617-870-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13558-CC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty