Provider Demographics
NPI:1619063088
Name:OLMSTEAD, EDWARD S (MED)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
Last Name:OLMSTEAD
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3000
Mailing Address - Country:US
Mailing Address - Phone:413-585-8284
Mailing Address - Fax:
Practice Address - Street 1:53 CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3000
Practice Address - Country:US
Practice Address - Phone:413-585-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1401C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health