Provider Demographics
NPI:1427238104
Name:EDWARDS, EMILY D (MSW)
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:D
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:D
Other - Last Name:EDWARDS-THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:222 INDIANAPOLIS BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1275
Mailing Address - Country:US
Mailing Address - Phone:219-808-0793
Mailing Address - Fax:219-756-0795
Practice Address - Street 1:222 INDIANAPOLIS BLVD STE 207
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1275
Practice Address - Country:US
Practice Address - Phone:219-808-0793
Practice Address - Fax:219-756-0795
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99025162A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN229790AOtherMEDICARE
IN200240460AMedicaid
IN229790AOtherMEDICARE