Provider Demographics
NPI:1396076592
Name:AUDETTE, HEATHER L (LMHC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:AUDETTE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 BOYLSTON ST.
Mailing Address - Street 2:5TH FLOOR #1166
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2774
Mailing Address - Country:US
Mailing Address - Phone:781-214-1858
Mailing Address - Fax:
Practice Address - Street 1:867 BOYLSTON ST.
Practice Address - Street 2:5TH FLOOR #1166
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2774
Practice Address - Country:US
Practice Address - Phone:781-214-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2023-01-10
Deactivation Date:2011-07-14
Deactivation Code:
Reactivation Date:2015-05-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1225745540OtherNPI2