Edinberg, Mark A
Edinberg, Mark A is an sole proprietor health care provider with primary practice located at 145 Marne Ave , Fairfield CT 06825-1752. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Edinberg, Mark A can be contacted via phone (203) 254-8372.Contact Information
Primary practice address
145 Marne Ave
Fairfield CT 06825-1752
Phone: (203) 254-8372
Fax: (203) 335-5497
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 748 | Connecticut |
Profile Details
| NPI number | 1750374625 |
|---|---|
| LBN Legal business name | Edinberg, Mark A |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 25th, 2005 |
| Last updated | Sep 2nd, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750374625 | NPPES |
| Connecticut | MEDICAID | 4100484 |
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