Provider Demographics
NPI:1114972866
Name:EDELSON, MARILYN (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:EDELSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WASHINGTON PARK
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1919
Mailing Address - Country:US
Mailing Address - Phone:617-306-9352
Mailing Address - Fax:617-879-0388
Practice Address - Street 1:60 AUSTIN ST STE 101
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1857
Practice Address - Country:US
Practice Address - Phone:617-964-3202
Practice Address - Fax:617-964-5675
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1003LL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01833Medicare UPIN