Provider Demographics
NPI:1902999261
Name:DALTON, EDWARD ROBERT (ACSW, LICSW, DCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ROBERT
Last Name:DALTON
Suffix:
Gender:M
Credentials:ACSW, LICSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PITT RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4952
Mailing Address - Country:US
Mailing Address - Phone:508-872-7672
Mailing Address - Fax:508-872-6558
Practice Address - Street 1:300 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5301
Practice Address - Country:US
Practice Address - Phone:508-872-7672
Practice Address - Fax:508-872-6558
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW, #106035-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADAP03997Medicare ID - Type UnspecifiedBC/BS, MEDICARE-B