Provider Demographics
NPI:1952073348
Name:PECORARO, HEATHER DAWN (MHC-LP)
Entity Type:Individual
Prefix:MR
First Name:HEATHER
Middle Name:DAWN
Last Name:PECORARO
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:MR
Other - First Name:HEATH
Other - Middle Name:DAWN
Other - Last Name:PECORARO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHC-LP
Mailing Address - Street 1:404 ZENA RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-2626
Mailing Address - Country:US
Mailing Address - Phone:845-679-8650
Mailing Address - Fax:845-679-5485
Practice Address - Street 1:404 ZENA RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-2626
Practice Address - Country:US
Practice Address - Phone:845-679-8650
Practice Address - Fax:845-679-5485
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112142-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health