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General NPI Number Information
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NPI Number | 1649897273
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Entity Type | Individual
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Provider Name | REGINA MARGARET EDMONDS PHD
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Gender | Female
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 971 OLD WEST BROOKFIELD RD
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City | WARREN
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State | MA
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Zip | 01083-2130
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Country | US
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Telephone | 413-436-9518
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 663
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City | WEST BROOKFIELD
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State | MA
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Zip | 01585-0663
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Country | US
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Telephone | 774-452-5159
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1918-PR
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License Number State | MA
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