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General NPI Number Information
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NPI Number | 1023345980
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Entity Type | Individual
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Provider Name | HEATHER LYNN HASTEDT LICSW
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Gender | Female
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 20 HOPE AVE STE 111
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City | WALTHAM
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State | MA
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Zip | 02453
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Country | US
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Telephone | 617-612-5202
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Fax |
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Provider Business Mailing Address
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Address Line | 23 DIX ST # 2
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City | WALTHAM
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State | MA
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Zip | 02453-6504
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Country | US
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Telephone | 248-770-0294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801089430
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 120080
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License Number State | MA
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