Provider Demographics
NPI:1528145182
Name:EDWARDS, BARBARA LANELLE (MSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LANELLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2214
Mailing Address - Country:US
Mailing Address - Phone:914-667-2468
Mailing Address - Fax:914-667-2468
Practice Address - Street 1:2002 SEAGIRT BLVD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2805
Practice Address - Country:US
Practice Address - Phone:718-327-7660
Practice Address - Fax:718-520-8045
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR008406-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY2201Medicare ID - Type Unspecified