Provider Demographics
NPI:1306972773
Name:EDELSTEIN, CAROL J (MSW LICSW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:J
Last Name:EDELSTEIN
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 VERNON STREET
Mailing Address - Street 2:FLR 3
Mailing Address - City:NORTHHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-584-7080
Mailing Address - Fax:
Practice Address - Street 1:16 VERNON STREET
Practice Address - Street 2:FLR 3
Practice Address - City:NORTHHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-584-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW106601041C0700X
MA106770104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04318OtherBLUE CROSS BLUE SHIELD
MA1892053OtherMASS HEALTH
MA1892053OtherMASSACHUSETTS BEHAVIORAL HEALTH PARTNERSHIP
MAP04318Medicare UPIN