Provider Demographics
NPI:1427117712
Name:EDWARDS, AUDRAY A (LCSW R ACSW BCD)
Entity type:Individual
Prefix:
First Name:AUDRAY
Middle Name:A
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW R ACSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 25 IVY RIDGE ROAD
Mailing Address - Street 2:25
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-4132
Mailing Address - Country:US
Mailing Address - Phone:315-478-2098
Mailing Address - Fax:
Practice Address - Street 1:16 CHURCH STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2710
Practice Address - Country:US
Practice Address - Phone:607-756-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0316221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical