Healthcare Provider Details

I. General information

NPI: 1750342796
Provider Name (Legal Business Name): HEIDI E. DONNELLAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MESSENGER ST
PLAINVILLE MA
02762-2258
US

IV. Provider business mailing address

60 MESSENGER ST
PLAINVILLE MA
02762-2258
US

V. Phone/Fax

Practice location:
  • Phone: 508-809-6378
  • Fax: 508-342-1913
Mailing address:
  • Phone: 508-809-6378
  • Fax: 508-342-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1022474
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: