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General NPI Number Information
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NPI Number | 1033921986
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Entity Type | Individual
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Provider Name | COLIN MICHAEL EDWARDS
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Gender | Male
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 14 FORDHAM RD
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City | ALLSTON
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State | MA
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Zip | 02134-3000
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Country | US
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Telephone | 774-786-0801
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Fax |
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Provider Business Mailing Address
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Address Line | 172 POND ST
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City | WINCHESTER
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State | MA
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Zip | 01890-1724
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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