Healthcare Provider Details

I. General information

NPI: 1598212433
Provider Name (Legal Business Name): HEATHER BOARDMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER KENNEDY LMFT

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 BOSTON ST
GUILFORD CT
06437-2855
US

IV. Provider business mailing address

512 LAKE DR
GUILFORD CT
06437-1160
US

V. Phone/Fax

Practice location:
  • Phone: 203-444-4518
  • Fax:
Mailing address:
  • Phone: 203-444-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001580
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: