Healthcare Provider Details

I. General information

NPI: 1225234198
Provider Name (Legal Business Name): HEIDI LYN KASSNER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI LYN PERKINS MSW

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 12/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 N MAIN ST SUITE 202
FALL RIVER MA
02720-2983
US

IV. Provider business mailing address

1563 N MAIN ST SUITE 202
FALL RIVER MA
02720-2983
US

V. Phone/Fax

Practice location:
  • Phone: 508-324-1060
  • Fax: 508-679-8590
Mailing address:
  • Phone: 508-324-1060
  • Fax: 508-679-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberG12787
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115249
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: