Healthcare Provider Details

I. General information

NPI: 1235288838
Provider Name (Legal Business Name): FELICIA M HEYWOOD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CENTRAL ST
WALTHAM MA
02453-5465
US

IV. Provider business mailing address

118 CENTRAL ST
WALTHAM MA
02453-5465
US

V. Phone/Fax

Practice location:
  • Phone: 781-891-0556
  • Fax: 781-647-1432
Mailing address:
  • Phone: 781-891-0556
  • Fax: 781-647-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number213595
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117661
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: