Provider Demographics
NPI:1811298623
Name:EDGAR, TIMOTHY CRAIG (LISW)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CRAIG
Last Name:EDGAR
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CASTERTON AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1516
Mailing Address - Country:US
Mailing Address - Phone:330-714-1450
Mailing Address - Fax:
Practice Address - Street 1:203 CASTERTON AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1516
Practice Address - Country:US
Practice Address - Phone:330-714-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.10002711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical