Provider Demographics
NPI:1750564449
Name:CRITERION-HERITAGE EARLY INTERVENTION
Entity type:Organization
Organization Name:CRITERION-HERITAGE EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CARPENTER
Authorized Official - Last Name:BRUFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:413-533-7140
Mailing Address - Street 1:5 LYMAN TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2623
Mailing Address - Country:US
Mailing Address - Phone:413-533-7140
Mailing Address - Fax:413-538-9757
Practice Address - Street 1:5 LYMAN TER
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2623
Practice Address - Country:US
Practice Address - Phone:413-533-7140
Practice Address - Fax:413-538-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency