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General NPI Number Information
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NPI Number | 1881701456
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Entity Type | Individual
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Provider Name | EDWARD J FEDERMAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | DAMONMILL SQUARE 2H-2 NORTH
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City | CONCORD
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State | MA
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Zip | 01742
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Country | US
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Telephone | 978-635-0400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2058
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City | ACTON
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State | MA
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Zip | 01720-6058
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Country | US
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Telephone | 978-635-0400
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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 | 2614
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License Number State | MA
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