MEDICARE: MS. MARILYN EDELSON MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	1003LL	MA

General Provider Information

NPI Number	:	1114972866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARILYN EDELSON MSW

Provider Business Mailing Address
First Line	:	90 WASHINGTON PARK
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02460-1919
Country	:	US
Telephone Number	:	617-306-9352
Fax Number	:	617-879-0388

Provider Business Practice Location Address
First Line	:	60 AUSTIN ST STE 101
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02460-1857
Country	:	US
Telephone Number	:	617-964-3202
Fax Number	:	617-964-5675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/06/2020

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