Provider Demographics
NPI:1871159467
Name:MASEWIC, HEATHYR (MS)
Entity type:Individual
Prefix:
First Name:HEATHYR
Middle Name:
Last Name:MASEWIC
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 LONDONDERRY TPKE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1977
Mailing Address - Country:US
Mailing Address - Phone:603-995-0925
Mailing Address - Fax:
Practice Address - Street 1:171 LONDONDERRY TPKE UNIT 7
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1977
Practice Address - Country:US
Practice Address - Phone:603-995-0925
Practice Address - Fax:603-932-2806
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1O23175072Medicaid