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General NPI Number Information
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NPI Number | 1114945482
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Entity Type | Individual
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Provider Name | DR. MARGARET MARY HEFFERNAN
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 330 BROOKLINE AVE BEHAVIORAL NEUROLOGY DEPT.
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City | BOSTON
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State | MA
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Zip | 02215-5400
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Country | US
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Telephone | 617-667-1317
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Fax | 617-667-7981
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Provider Business Mailing Address
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Address Line | 407 ROUNSEVILLE RD
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City | ROCHESTER
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State | MA
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Zip | 02770-2009
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Country | US
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Telephone | 617-667-1317
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Fax | 617-667-7981
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 6704
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License Number State | MA
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