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General NPI Number Information
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NPI Number | 1356821607
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Entity Type | Individual
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Provider Name | EDWARD YATES BA
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Gender | Male
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 23 MELLEN ST
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City | CAMBRIDGE
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State | MA
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Zip | 02138-2757
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Country | US
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Telephone | 617-349-8545
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Fax |
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Provider Business Mailing Address
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Address Line | 15 DEXTER ST APT 4
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City | WALTHAM
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State | MA
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Zip | 02453-5069
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Country | US
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Telephone | 813-351-0845
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 127177
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License Number State | MA
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