Provider Demographics
NPI:1912613373
Name:NICK HEATH LICSW, LLC
Entity Type:Organization
Organization Name:NICK HEATH LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-320-3876
Mailing Address - Street 1:25 WARREN AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6150
Mailing Address - Country:US
Mailing Address - Phone:617-320-3876
Mailing Address - Fax:
Practice Address - Street 1:25 WARREN AVE APT 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-6150
Practice Address - Country:US
Practice Address - Phone:617-320-3876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty