Healthcare Provider Details

I. General information

NPI: 1518190198
Provider Name (Legal Business Name): MARY E HECK LICSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 PRINCETON DR UNIT 306
HOOKSETT NH
03106-1750
US

IV. Provider business mailing address

90 PRINCETON DR UNIT 306
HOOKSETT NH
03106-1750
US

V. Phone/Fax

Practice location:
  • Phone: 717-343-8685
  • Fax:
Mailing address:
  • Phone: 717-343-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW119348
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017870
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier119348
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerSOCIAL WORK LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: