Healthcare Provider Details

I. General information

NPI: 1043663222
Provider Name (Legal Business Name): MR. DENNIS R. EDWARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 31ST ST
OAKLAND CA
94609-3204
US

IV. Provider business mailing address

PO BOX 91
ALAMO CA
94507-0091
US

V. Phone/Fax

Practice location:
  • Phone: 510-379-4394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: