Organization
BLUE HERON THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATELYN EMMA LICSW (SOLE MEMBER)
(774) 573-6185
Entity
Organization
Contact information
Practice address
165 MAIN ST UNIT 203, MEDWAY, MA 02053-1584
(774) 613-0436
Mailing address
165 MAIN ST UNIT 203, MEDWAY, MA 02053-1584
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/15/2021
Last updated
09/15/2021
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