Provider Demographics
NPI:1972856243
Name:HEFFERNAN, JOAN Y
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:Y
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WALTHAM ST
Mailing Address - Street 2:PMB 233
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7934
Mailing Address - Country:US
Mailing Address - Phone:781-676-0000
Mailing Address - Fax:781-676-0067
Practice Address - Street 1:21 FRANKLIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4951
Practice Address - Country:US
Practice Address - Phone:781-676-0000
Practice Address - Fax:781-676-0067
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9511103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical