Healthcare Provider Details

I. General information

NPI: 1528014867
Provider Name (Legal Business Name): CAROL HEPPEN-GORDON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 BOSTON POST RD SUITE 450
MARLBORO MA
01752
US

IV. Provider business mailing address

25 NORMANDY DR
SUDBURY MA
01776-2121
US

V. Phone/Fax

Practice location:
  • Phone: 508-460-9633
  • Fax: 508-481-2609
Mailing address:
  • Phone: 978-443-7952
  • Fax: 508-481-2609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102527
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: