MEDICARE: AQUILLA EDWARDS PH.D.

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	103T00000X	Psychologist	021746	NY
2	103T00000X	Psychologist	39751	TX

General Provider Information

NPI Number	:	1548658826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AQUILLA EDWARDS PH.D.

Provider Business Mailing Address
First Line	:	5729 LEBANON RD. STE. 144
Second Line	:	#564
City	:	FRISCO
State	:	TX
Zip	:	75034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5729 LEBANON RD STE 144
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-7259
Country	:	US
Telephone Number	:	212-780-2500
Fax Number	:

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

Provider Enumeration Date	:	01/08/2015
Last Update Date	:	08/27/2024

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Directions to “ AQUILLA EDWARDS PH.D.” Practice Location

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