Basic Information
| Provider Information | |||||||||
| NPI: | 1598900847 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAWRENCE | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | DEARINGTON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | #507 ROUTE 197 | ||||||||
| Address2: | P.O.BOX 277 | ||||||||
| City: | EAST WOODSTOCK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062440277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609632237 | ||||||||
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| Practice Location | |||||||||
| Address1: | 340 MAIN ST. | ||||||||
| Address2: | SUITE 383 | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087914976 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2008 | ||||||||
| LastUpdateDate: | 12/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.