Healthcare Provider Details

I. General information

NPI: 1154278448
Provider Name (Legal Business Name): MS. BREANNA EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 MAIN ST FL 3
MALDEN MA
02148-5054
US

IV. Provider business mailing address

PO BOX 88
HATHORNE MA
01937-0188
US

V. Phone/Fax

Practice location:
  • Phone: 617-804-2773
  • Fax: 617-221-5680
Mailing address:
  • Phone: 347-506-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: