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1073617353

NPI Code Detail

MEDICARE: EDINBURG CENTER INC

MEDICARE: EDINBURG CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist
2	1041C0700X	Clinical Social Worker
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
4	2084P0800X	Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1303287	OTHER	MA	MBHP
2	1303237	OTHER	MA	MBHP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1304267	OTHER	MA	MBHP
6	M18633	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1073617353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDINBURG CENTER INC

Provider Business Mailing Address
First Line	:	205 BURLINGTON RD
Second Line	:
City	:	BEDFORD
State	:	MA
Zip	:	01730-1406
Country	:	US
Telephone Number	:	781-761-5064
Fax Number	:	781-275-7205

Provider Business Practice Location Address
First Line	:	205 BURLINGTON RD
Second Line	:
City	:	BEDFORD
State	:	MA
Zip	:	01730-1406
Country	:	US
Telephone Number	:	781-761-5208
Fax Number	:	781-275-7205

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MARINA KAGAN
Credential	:
Telephone Number	:	781-761-5208

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	06/29/2022

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Directions to “EDINBURG CENTER INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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