Provider Demographics
NPI:1932671823
Name:HETZEL, THERESE (LICSW)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:HETZEL
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 1:865 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-1316
Mailing Address - Country:US
Mailing Address - Phone:781-433-6613
Mailing Address - Fax:781-444-5388
Practice Address - Street 1:865 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-1316
Practice Address - Country:US
Practice Address - Phone:781-433-6613
Practice Address - Fax:781-444-5388
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1136641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical