MEDICARE: MR. STEVEN R EDELMAN MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	364	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184750655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN R EDELMAN MA

Provider Business Mailing Address
First Line	:	345 LOCHSTONE CT
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5139
Country	:	US
Telephone Number	:	910-868-6565
Fax Number	:	910-486-1590

Provider Business Practice Location Address
First Line	:	907 HAY ST STE 203
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5352
Country	:	US
Telephone Number	:	910-826-3694
Fax Number	:	910-486-1590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	02/07/2014

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