Healthcare Provider Details

I. General information

NPI: 1154980670
Provider Name (Legal Business Name): NATHALIE EDMOND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2019
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SCOTCH RD STE E
EWING NJ
08628-2529
US

IV. Provider business mailing address

20 SCOTCH RD STE E
EWING NJ
08628-2529
US

V. Phone/Fax

Practice location:
  • Phone: 609-403-6359
  • Fax: 609-357-9488
Mailing address:
  • Phone: 609-403-6359
  • Fax: 609-357-9488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHALIE EDMOND
Title or Position: OWNER
Credential: PSYD
Phone: 609-477-4573