Provider Demographics
NPI:1982758710
Name:EDMONDS, LILLIAN S
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:S
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:
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 640
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-0640
Mailing Address - Country:US
Mailing Address - Phone:978-500-9786
Mailing Address - Fax:508-681-8418
Practice Address - Street 1:455 SAMPSONS MILL RD STE G
Practice Address - Street 2:
Practice Address - City:COTUIT
Practice Address - State:MA
Practice Address - Zip Code:02635-2725
Practice Address - Country:US
Practice Address - Phone:978-500-9786
Practice Address - Fax:508-681-8418
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2022-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312294Medicaid