Provider Demographics
NPI:1386717031
Name:REDMOND, EDWARD SWEENEY (LICSW)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:SWEENEY
Last Name:REDMOND
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7198
Mailing Address - Street 2:25 COUNTRY CLUB RD VILLAGE WEST I STE 405
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03247
Mailing Address - Country:US
Mailing Address - Phone:603-293-0395
Mailing Address - Fax:603-293-0395
Practice Address - Street 1:25 COUNTRY CLUB RD
Practice Address - Street 2:VILLAGE WEST I STE 405
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03247
Practice Address - Country:US
Practice Address - Phone:603-293-0395
Practice Address - Fax:603-293-0395
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30423994Medicaid
RE3249Medicare ID - Type Unspecified