Provider Demographics
NPI:1093761066
Name:NEUHAUS, EDMUND CONRAD (PHD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:CONRAD
Last Name:NEUHAUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 GROVE ST
Mailing Address - Street 2:SUITE 2-400
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2272
Mailing Address - Country:US
Mailing Address - Phone:617-663-4948
Mailing Address - Fax:617-663-4801
Practice Address - Street 1:275 GROVE ST
Practice Address - Street 2:SUITE 2-400
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-2272
Practice Address - Country:US
Practice Address - Phone:617-663-4948
Practice Address - Fax:617-663-4801
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4826103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04593OtherBCBS
MAW04593Medicare ID - Type Unspecified