Individual
MICHAEL HEFFERNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW, LCDP
Contact information
Practice address
345 BLACKSTONE BLVD, PROVIDENCE, RI 02906-4800
(401) 421-7900
Mailing address
41 NORMAN AVE, CRANSTON, RI 02910-5812
(401) 941-0804
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDP 00193
RI
1041C0700X
Clinical Social Worker
ISW 00358
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205032
RI BLUECROSS-BLUECHIP
RI
01
—
23588-4
RI BLUECROSS-BLUESHIELD
RI
01
—
62-52319
UNITEDBEHAVIORALHEALTH
RI
Enumeration date
11/20/2006
Last updated
09/11/2025
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