Provider Demographics
NPI:1700135589
Name:MOSS, HEIDI A (LMHC)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:A
Last Name:MOSS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3590
Mailing Address - Country:US
Mailing Address - Phone:781-438-0038
Mailing Address - Fax:781-438-2398
Practice Address - Street 1:228 MAIN ST.
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3590
Practice Address - Country:US
Practice Address - Phone:781-438-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health