Healthcare Provider Details

I. General information

NPI: 1619063088
Provider Name (Legal Business Name): EDWARD S OLMSTEAD M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 CENTER ST
NORTHAMPTON MA
01060-3000
US

IV. Provider business mailing address

53 CENTER ST
NORTHAMPTON MA
01060-3000
US

V. Phone/Fax

Practice location:
  • Phone: 413-585-8284
  • Fax:
Mailing address:
  • Phone: 413-585-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1401C
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: