Provider Demographics
NPI:1609393628
Name:EDMUNDSON, MARYANNE SARAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARYANNE
Middle Name:SARAH
Last Name:EDMUNDSON
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:45 AVIEMORE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9797
Mailing Address - Country:US
Mailing Address - Phone:910-420-8041
Mailing Address - Fax:910-420-8071
Practice Address - Street 1:45 AVIEMORE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9797
Practice Address - Country:US
Practice Address - Phone:910-420-8041
Practice Address - Fax:910-420-8071
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5217103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist