Provider Demographics
NPI:1760501514
Name:TALBOT, EDMOND P (LADC-1)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:P
Last Name:TALBOT
Suffix:
Gender:M
Credentials:LADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-1242
Mailing Address - Country:US
Mailing Address - Phone:508-542-1959
Mailing Address - Fax:
Practice Address - Street 1:161 NORTH ST
Practice Address - Street 2:
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739-1242
Practice Address - Country:US
Practice Address - Phone:508-542-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1421101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)