Provider Demographics
NPI:1366955007
Name:QUERCIA, HEATHER CHILD (LICSW AND LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:CHILD
Last Name:QUERCIA
Suffix:
Gender:F
Credentials:LICSW AND LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:EAST WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06244-0064
Mailing Address - Country:US
Mailing Address - Phone:860-576-3092
Mailing Address - Fax:
Practice Address - Street 1:63 HARMONY HILL RD
Practice Address - Street 2:
Practice Address - City:CHEPACHET
Practice Address - State:RI
Practice Address - Zip Code:02814-1429
Practice Address - Country:US
Practice Address - Phone:401-949-0690
Practice Address - Fax:401-349-2028
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW027481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty