Healthcare Provider Details

I. General information

NPI: 1861188757
Provider Name (Legal Business Name): AUSTIN J HEFFERNAN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 FARMINGTON AVE STE 346
FARMINGTON CT
06032-1909
US

IV. Provider business mailing address

336 CENTER RD APT 17C
VERNON CT
06066-4158
US

V. Phone/Fax

Practice location:
  • Phone: 860-878-1433
  • Fax:
Mailing address:
  • Phone: 860-878-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number27.002937
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: