Provider Demographics
NPI:1881701456
Name:FEDERMAN, EDWARD J (PHD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:FEDERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2058
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-6058
Mailing Address - Country:US
Mailing Address - Phone:978-635-0400
Mailing Address - Fax:
Practice Address - Street 1:DAMONMILL SQUARE
Practice Address - Street 2:2H-2 NORTH
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-635-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2614103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical