Provider Demographics
NPI:1366986812
Name:EDWARDS MENTORING AND SOCIAL SERVICES, LMSW, P.L.L.C.
Entity type:Organization
Organization Name:EDWARDS MENTORING AND SOCIAL SERVICES, LMSW, P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:646-824-5737
Mailing Address - Street 1:19005 122ND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1010
Mailing Address - Country:US
Mailing Address - Phone:646-824-5737
Mailing Address - Fax:
Practice Address - Street 1:19005 122ND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1010
Practice Address - Country:US
Practice Address - Phone:646-824-5737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092982101Y00000X, 171M00000X, 251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1699170365Medicaid