Healthcare Provider Details

I. General information

NPI: 1144545344
Provider Name (Legal Business Name): AMBER N EDINOFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AMBER N GARDNER

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MILL ST
BELMONT MA
02478-1048
US

IV. Provider business mailing address

115 MILL ST
BELMONT MA
02478-1048
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-3803
  • Fax:
Mailing address:
  • Phone: 617-855-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR76606
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number290911
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number290911
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: