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General NPI Number Information
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NPI Number | 1477271641
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Entity Type | Individual
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Provider Name | JAVONTE EDWARDS
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Gender | Male
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 110 BOSTON STREET, SALEM, MA 01970 2
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City | LYNN
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State | MA
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Zip | 01902-0190
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Country | US
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Telephone | 781-990-9675
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Fax |
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Provider Business Mailing Address
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Address Line | 64 CHATHAM ST APT 2
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City | LYNN
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State | MA
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Zip | 01902-2448
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Country | US
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Telephone | 781-990-9675
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | MA
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