Provider Demographics
NPI:1487703252
Name:ONTRACK COACHING & CONSULTING, INC
Entity type:Organization
Organization Name:ONTRACK COACHING & CONSULTING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, BCD
Authorized Official - Phone:617-964-3202
Mailing Address - Street 1:197 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2516
Mailing Address - Country:US
Mailing Address - Phone:617-964-3202
Mailing Address - Fax:
Practice Address - Street 1:197 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2516
Practice Address - Country:US
Practice Address - Phone:617-964-3202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1003221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP10244OtherBLUE CROSS SHIELD OF MA
MA723405OtherTUFTS HEALTH PLAN
MA=========Y1ED88OtherMAGELLAN