Provider Demographics
NPI:1154637247
Name:WRIGHT, EDWARD NATHANIEL (LICSW)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:NATHANIEL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 THORNDIKE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5858
Mailing Address - Country:US
Mailing Address - Phone:978-290-2421
Mailing Address - Fax:
Practice Address - Street 1:8 THORNDIKE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5858
Practice Address - Country:US
Practice Address - Phone:978-290-2421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1183641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical