Provider Demographics
NPI:1366647356
Name:EDMONSTONE, JAMES WALKER (LICSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WALKER
Last Name:EDMONSTONE
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 1:78 MAIN ST
Mailing Address - Street 2:SUITE # 404
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-586-0098
Mailing Address - Fax:413-586-0083
Practice Address - Street 1:78 MAIN ST
Practice Address - Street 2:SUITE # 404
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-586-0098
Practice Address - Fax:413-586-0083
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1034841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1853341Medicaid
MA1892673OtherMBHP
MAP02314OtherBCBS
MAP02314OtherBCBS