Provider Demographics
NPI:1629835640
Name:EIDUSON, JOSPEH H
Entity Type:Individual
Prefix:MR
First Name:JOSPEH
Middle Name:H
Last Name:EIDUSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CIRRUS DR APT 5102
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-4453
Mailing Address - Country:US
Mailing Address - Phone:617-416-5005
Mailing Address - Fax:
Practice Address - Street 1:1280 MAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1861
Practice Address - Country:US
Practice Address - Phone:508-754-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health