Provider Demographics
NPI:1588728513
Name:HEASLEY, WILLIAM DERRY (PSYD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DERRY
Last Name:HEASLEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 EASTERN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1869
Mailing Address - Country:US
Mailing Address - Phone:978-282-8281
Mailing Address - Fax:978-282-1143
Practice Address - Street 1:85 EASTERN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1869
Practice Address - Country:US
Practice Address - Phone:978-282-8281
Practice Address - Fax:978-282-1143
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7033103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05600OtherCLINICAL PSYCHOLOGIST
MAW05600OtherCLINICAL PSYCHOLOGIST