1104959469 NPI number — NATASHA EDELHAUS LMFT

Table of content: NATASHA EDELHAUS LMFT (NPI 1104959469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104959469 NPI number — NATASHA EDELHAUS LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDELHAUS
Provider First Name:
NATASHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104959469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
756 WASHINGTON ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOUGHTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02072-2976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-708-4504
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9935 ALCOSTA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN RAMON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94583-3057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-864-0539
Provider Business Practice Location Address Fax Number:
925-999-9627
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  059909 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: LMFT40591 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1104959469 . This is a "LYRA HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1104959469 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1104959469 . This is a "BLUE CROSS BLUE SHIELD OF CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1104959469 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1104959469 . This is a "AETNA HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1104959469 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1104959469 . This is a "UMR" identifier . This identifiers is of the category "OTHER".




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