Provider Demographics
NPI:1649288655
Name:HETHERINGTON, LAURA BURTT (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BURTT
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:296 AL HARVEY RD
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378-1902
Mailing Address - Country:US
Mailing Address - Phone:860-917-5054
Mailing Address - Fax:
Practice Address - Street 1:11 MAIN ST STE 11-211A
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-3654
Practice Address - Country:US
Practice Address - Phone:860-415-6165
Practice Address - Fax:860-701-3776
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical