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Individual

THOMAS HEFFERNAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MS

Contact information

Practice address
130 DIVISION STREET, GRIFFIN HOSPITAL, DERBY, CT 06418
(203) 732-7550
(203) 732-1550
Mailing address
130 DIVISION STREET, GRIFFIN HOSPITAL, DERBY, CT 06418
(203) 732-7550
(203) 732-1550

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
06-0640714
GRIFFIN HOSPITAL TAX ID
CT
Enumeration date
11/07/2008
Last updated
11/07/2008
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