Provider Demographics
NPI:1902081920
Name:ANDERSON, HEIDI FACTOR (LICSW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:FACTOR
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:SHERYL
Other - Last Name:FACTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:380 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3745
Mailing Address - Country:US
Mailing Address - Phone:978-266-1991
Mailing Address - Fax:
Practice Address - Street 1:380 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3745
Practice Address - Country:US
Practice Address - Phone:978-266-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA01290521041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool