Provider Demographics
NPI:1558946699
Name:TONELLI, EDITH ANN (MA PHD)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:ANN
Last Name:TONELLI
Suffix:
Gender:F
Credentials:MA PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 W GREAT WESTERN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-1034
Mailing Address - Country:US
Mailing Address - Phone:508-737-2098
Mailing Address - Fax:
Practice Address - Street 1:36 W GREAT WESTERN ST
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1034
Practice Address - Country:US
Practice Address - Phone:508-737-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1199106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist