Provider Demographics
NPI:1891929980
Name:EDGELL, RENE ANSEVIN (MED)
Entity Type:Individual
Prefix:MS
First Name:RENE
Middle Name:ANSEVIN
Last Name:EDGELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 STRUTHERS RD
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-2167
Mailing Address - Country:US
Mailing Address - Phone:412-860-8701
Mailing Address - Fax:
Practice Address - Street 1:950 WINDHAM CT
Practice Address - Street 2:SUITE 4
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5083
Practice Address - Country:US
Practice Address - Phone:330-629-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst