Provider Demographics
NPI:1760356281
Name:EDWARDS, ALEX EMANUEL
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:EMANUEL
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:N
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:472A WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2026
Mailing Address - Country:US
Mailing Address - Phone:857-453-0148
Mailing Address - Fax:857-453-0148
Practice Address - Street 1:472A WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124-2026
Practice Address - Country:US
Practice Address - Phone:857-453-0148
Practice Address - Fax:857-453-0148
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health