Provider Demographics
NPI:1043068422
Name:RAIMBAULT, EDWIGE
Entity type:Individual
Prefix:
First Name:EDWIGE
Middle Name:
Last Name:RAIMBAULT
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 1:270 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-1520
Mailing Address - Country:US
Mailing Address - Phone:781-910-1339
Mailing Address - Fax:
Practice Address - Street 1:3 BLACKBURN CTR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2268
Practice Address - Country:US
Practice Address - Phone:978-264-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health