Healthcare Provider Details

I. General information

NPI: 1538032917
Provider Name (Legal Business Name): AMANDA HEFFERNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 FRANKLIN ST
LYNN MA
01904-3230
US

IV. Provider business mailing address

255 NORTHAMPTON ST UNIT 602
BOSTON MA
02118-4711
US

V. Phone/Fax

Practice location:
  • Phone: 781-593-2727
  • Fax: 781-780-0099
Mailing address:
  • Phone: 203-858-7727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: