Provider Demographics
NPI:1942684121
Name:STAFFORD, HEATHER (MSTCM, LAC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MSTCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4706
Mailing Address - Country:US
Mailing Address - Phone:203-823-8468
Mailing Address - Fax:
Practice Address - Street 1:499 FEDERAL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2041
Practice Address - Country:US
Practice Address - Phone:203-823-8468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT630171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist