Healthcare Provider Details

I. General information

NPI: 1508936865
Provider Name (Legal Business Name): KELLY A HECK LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY A SHUFF-HECK

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/26/2022
Certification Date: 12/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WENDELL AVENUE EXT STE 201
PITTSFIELD MA
01201-6283
US

IV. Provider business mailing address

166 HIGHLAND AVE
PITTSFIELD MA
01201-2419
US

V. Phone/Fax

Practice location:
  • Phone: 413-358-5697
  • Fax:
Mailing address:
  • Phone: 413-358-5697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113261
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: