Provider Demographics
NPI:1588174775
Name:HEIDI D. HUGHART, LLC
Entity type:Organization
Organization Name:HEIDI D. HUGHART, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUGHART
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-415-8495
Mailing Address - Street 1:365 E MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2927
Mailing Address - Country:US
Mailing Address - Phone:203-415-8495
Mailing Address - Fax:
Practice Address - Street 1:365 E MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2927
Practice Address - Country:US
Practice Address - Phone:203-415-8495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008064088Medicaid