Provider Demographics
NPI:1710016548
Name:EDMOND, NATHALIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:
Last Name:EDMOND
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SCOTCH RD STE E
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2529
Mailing Address - Country:US
Mailing Address - Phone:609-403-6359
Mailing Address - Fax:609-357-9488
Practice Address - Street 1:20 SCOTCH RD STE E
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-2529
Practice Address - Country:US
Practice Address - Phone:609-403-6359
Practice Address - Fax:609-357-9488
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00427400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097193Medicare ID - Type Unspecified