MEDICARE: HERITAGE FAMILY COUNSELING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	105193	MA

General Provider Information

NPI Number	:	1295049500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE FAMILY COUNSELING CENTER

Provider Business Mailing Address
First Line	:	60 RAILROAD AVE
Second Line	:
City	:	S HAMILTON
State	:	MA
Zip	:	01982-2219
Country	:	US
Telephone Number	:	978-468-7010
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 RAILROAD AVE
Second Line	:
City	:	S HAMILTON
State	:	MA
Zip	:	01982-2219
Country	:	US
Telephone Number	:	978-468-7010
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ROBERT KAUFMAN
Credential	:	MSW
Telephone Number	:	978-468-7010

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	07/28/2010

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