Healthcare Provider Details

I. General information

NPI: 1083571749
Provider Name (Legal Business Name): EDITH PROPHETE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 HARRISON AVE STE 230207
BOSTON MA
02118-2304
US

IV. Provider business mailing address

660 HARRISON AVE STE 230207 SUITE 230/207
BOSTON MA
02118-2304
US

V. Phone/Fax

Practice location:
  • Phone: 617-446-3165
  • Fax:
Mailing address:
  • Phone: 617-446-3165
  • Fax: 617-238-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2339494
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: