Provider Demographics
NPI:1194910232
Name:DWYER-HEIDKAMP, BARBARA JOAN (MA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JOAN
Last Name:DWYER-HEIDKAMP
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1011
Mailing Address - Country:US
Mailing Address - Phone:781-245-8012
Mailing Address - Fax:
Practice Address - Street 1:338 MAIN ST. SUITE 304
Practice Address - Street 2:RIVERSIDE OUTPATIENT CENTER
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-246-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health