Provider Demographics
NPI:1386902021
Name:EDWARDS, JOHN R (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MSW, LCSW
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 491
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94604-0491
Mailing Address - Country:US
Mailing Address - Phone:510-213-9284
Mailing Address - Fax:
Practice Address - Street 1:431 30TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3307
Practice Address - Country:US
Practice Address - Phone:510-213-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW600585251041C0700X
CALCS 207291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical