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General NPI Number Information
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NPI Number | 1134589708
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Entity Type | Organization
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Legal Business Name | JAMES EDMONSTONE
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Dates
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Enumeration Date | 02/25/2016
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 78 MAINST. SUITE 404
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City | NORTHAMPTON
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State | MA
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Zip | 01060
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Country | US
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Telephone | 413-586-0098
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Fax | 413-586-0083
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Provider Business Mailing Address
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Address Line | 78 MAINST. SUITE 404
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City | NORTHAMPTON
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State | MA
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Zip | 01060
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Country | US
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Telephone | 413-586-0098
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Fax | 413-586-0083
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Authorized Official
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Title or Position | LICENSED INDEPENDENT CLINICAL SOC
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Name | JAMES WALKER EDMONSTONE
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Credential | LICSW
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Telephone | 413-586-0098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 103484
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License Number State | MA
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