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NPI Code Detail

MEDICARE: MR. EDWARD YATES BA

MEDICARE: MR. EDWARD YATES BA
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
11041C0700XClinical Social Worker127177MA

General Provider Information

NPI Number : 1356821607
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDWARD YATES BA
Provider Business Mailing Address
First Line : 15 DEXTER ST APT 4
Second Line :
City : WALTHAM
State : MA
Zip : 02453-5069
Country : US
Telephone Number : 813-351-0845
Fax Number :
Provider Business Practice Location Address
First Line : 23 MELLEN ST
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02138-2757
Country : US
Telephone Number : 617-349-8545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2018
Last Update Date : 07/15/2024

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