Healthcare Provider Details

I. General information

NPI: 1992616536
Provider Name (Legal Business Name): MS. ATHENA EDMONDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EDGARTOWN ROAD
OAK BLUFFS MA
02568
US

IV. Provider business mailing address

30 SHADY BROOK LN
BELMONT MA
02478-2001
US

V. Phone/Fax

Practice location:
  • Phone: 508-693-7900
  • Fax: 508-696-0401
Mailing address:
  • Phone: 508-693-7900
  • Fax: 508-696-0401

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: