Healthcare Provider Details

I. General information

NPI: 1497541338
Provider Name (Legal Business Name): HEATHER M BOSTON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 WINTER ST STE 340
WALTHAM MA
02451-8766
US

IV. Provider business mailing address

281 WINTER ST STE 340
WALTHAM MA
02451-8766
US

V. Phone/Fax

Practice location:
  • Phone: 781-474-5225
  • Fax:
Mailing address:
  • Phone: 781-474-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10004670
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: