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General NPI Number Information
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NPI Number | 1487703252
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Entity Type | Organization
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Legal Business Name | ONTRACK COACHING & CONSULTING, INC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 197 MOUNT VERNON ST
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City | WEST NEWTON
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State | MA
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Zip | 02465-2516
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Country | US
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Telephone | 617-964-3202
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Fax |
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Provider Business Mailing Address
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Address Line | 197 MOUNT VERNON ST
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City | WEST NEWTON
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State | MA
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Zip | 02465-2516
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Country | US
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Telephone | 617-964-3202
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARILYN EDELSON
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Credential | LICSW, BCD
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Telephone | 617-964-3202
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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 | 100322
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License Number State | MA
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