Doctor Name: | MR. EDWARD L. POWERS |
NPI Number: | 1104915172 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 5678 |
Business Practice Address: | 128 Main St Gloucester, MA - 019305725 |
Business Phone Number: | 9784309965 |
Business Fax Number: | 9782831604 |
Mailing Address: | 128 Main St., GLOUCESTER |
State: | MA |
Postal Code: | 01930 |
Phone Number: | 9784309965 |
Fax Number: | 9782831604 |
NPI Enumeration Date: | 10/11/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 5678 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |