Provider Demographics
NPI:1336387398
Name:EDWARDS, SANDRA LEE (LMSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 OLMSTEAD AVE
Mailing Address - Street 2:SUITE # 3A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1745
Mailing Address - Country:US
Mailing Address - Phone:718-792-5725
Mailing Address - Fax:
Practice Address - Street 1:633 OLMSTEAD AVE
Practice Address - Street 2:SUITE # 3A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-1745
Practice Address - Country:US
Practice Address - Phone:718-792-5725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073874104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker