Basic Information
| Provider Information | |||||||||
| NPI: | 1881744209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HECK | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 CHURCHILL AVE | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024767822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816469086 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1261 FURNACE BROOK PKWY | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021694721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174794545 | ||||||||
| FaxNumber: | 6174794555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 0139 | MA | X | Behavioral Health & Social Service Providers | Psychologist | 103G00000X | 0139 | MA | X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.