Healthcare Provider Details

I. General information

NPI: 1548574601
Provider Name (Legal Business Name): HEATHER MARIE KEDDY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2010
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WASHINGTON ST
CANTON MA
02021-2574
US

IV. Provider business mailing address

9 HARDING ST
SHARON MA
02067
US

V. Phone/Fax

Practice location:
  • Phone: 781-821-5050
  • Fax:
Mailing address:
  • Phone: 781-439-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: