Basic Information
| Provider Information | |||||||||
| NPI: | 1770871501 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATASHA EDELHAUS ENTERPRISES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 WALNUT ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024601689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172443322 | ||||||||
| FaxNumber: | 6175816040 | ||||||||
| Practice Location | |||||||||
| Address1: | 756 WASHINGTON ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | STOUGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020722969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818640583 | ||||||||
| FaxNumber: | 7813417272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2011 | ||||||||
| LastUpdateDate: | 07/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | EDELHAUS | ||||||||
| AuthorizedOfficialFirstName: | NATASHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7818640583 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 1274 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.