Healthcare Provider Details

I. General information

NPI: 1700033941
Provider Name (Legal Business Name): EVANGELIA LAMBIDONI EDM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1269 BEACON ST
BROOKLINE MA
02446-5248
US

IV. Provider business mailing address

1400 COMMONWEALTH AVE APT. 6
ALLSTON MA
02134-3613
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-1303
  • Fax:
Mailing address:
  • Phone: 617-505-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number396906
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: