MEDICARE: DEBBIE BUTLER EDWARDS

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1538389374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE BUTLER EDWARDS

Provider Business Mailing Address
First Line	:	841 JIMMY ANN DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-4583
Country	:	US
Telephone Number	:	386-274-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	841 JIMMY ANN DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-4583
Country	:	US
Telephone Number	:	386-274-5333
Fax Number	:

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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