Provider Demographics
NPI:1669822292
Name:NORRIS, EDWARD KINGSLEY
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:KINGSLEY
Last Name:NORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:NED
Other - Middle Name:KINGSLEY
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:219 EAGLE MOUNTAIN HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3430
Mailing Address - Country:US
Mailing Address - Phone:802-734-8008
Mailing Address - Fax:
Practice Address - Street 1:50 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3909
Practice Address - Country:US
Practice Address - Phone:413-587-7548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist